气管切开术后气道获得性感染的致病菌及其药敏  

The acquired respiratory infection of postoperative patients with opening tracheas

作　　者：谭平国[1] 钟伟健[1] 张灿嫦[1] 钟志光[1] 林吉惠[1] 

机构地区：[1]中山医科大学孙逸仙纪念医院神经外科

出　　处：《中华外科杂志》1998年第A00期38-40,共3页Chinese Journal of Surgery

摘　　要：目的研究气管切开术后患者呼吸道获得性感染的发生率、致病菌、药敏与耐药情况。方法分析１９９２年７月～１９９７年８月间，神经外科ＩＣＵ中，４５例昏迷患者气管切开术后呼吸道分泌物的细菌培养、药敏资料。结果４５例１１４次痰培养阳性１１０例，阳性率９６％。其中细菌９４株，占８５％，共２０个菌种；霉菌１６株，占１５％，均为真菌。８例厌氧菌送检，阳性３例。细菌与真菌混合感染１１例，二重感染率达２５％。革蓝阴性（Ｇ－）杆菌主要是绿脓杆菌（３５％），不动杆菌（１５％），大肠杆菌（５４％），三者共占５５４％。革蓝阳性（Ｇ＋）球菌主要是表皮样葡萄球菌（１５％），金黄色葡萄球菌（７５％），粪链球菌（３％），三者共占２５５％。药敏试验结果为：对青霉素类、三代头孢、喹诺酮、氨基糖甙类、青霉烯类Ｇ－杆菌分别为２０％～３０％、４０％～６０％、８８％、９０％和９２％。Ｇ＋球菌则分别为８５％、３０％～５０％、８５％、８５％、９５％。结论气管切开术后呼吸道获得性感染是抢救危重患者一个严重的问题。病原菌的耐药与交叉耐药日趋普遍，广谱抗菌素的滥用又常常导致霉菌感染，厌氧菌感染及微生物敏感性试验为抢救危重患者不可忽视的难题。Objective To study the acquired respiratory infection rate, pathogens and drug resistance of postoperative patients with opening tracheas in cranial surgical ICU and to explore the treatment and prevention methods. Method The bacterial culture and drug sensitivity assays of 45 postoperative patients with opening tracheas were analyzed. Result 110 of 114 bacterial cultures were positive in 45 patients identified with a positive rate of 96%. 94 lines (85%) of 20 bacterial species and 16 lines of fungi were found. Three of 8 patients showed positive anaerobic infection. 11 patients showed combined infection of bacteria and fungi, with a double infection rate of 25%. Gram′s negative bacteria (55 4%) included pseudomonas aeruginosa (35%), bacilla (15%), bacillus coli (5 4%), Gram′s positive bacteria (25 5%) included staphylococcus epidermidis, staphylococcus aureus (7 5%), and staphylococcus coprogenus (3%). The sensitivity of a Graun′s negative bacteria to PG, 3rd generation cephalosporin, norfloxacin, Gram′s aminoglycosides and penicillenic acids was 20%～30%, 40%～60%, 88%～90% and 92% respectively but Gram′s positive bacteria 85%, 30%～50%, 85%, 85%,95% respectively. Conclusion Acquired respiratory infection after opening tracheas in cranial surgical ICU is a main problem encountered in treatment. And drug resistant or cross resistant bacteria are popular. Abuse of general antibiotics leads to double infection, and anaerobic infection is unneglectable in treating severe patients.

关 键 词：气管切开 呼吸道感染 致病菌 药敏试验 

分 类 号：R768[医药卫生—耳鼻咽喉科] R653[医药卫生—临床医学]