预防性应用抗生素对气胸患者胸管定植菌的影响  

Effects of prophylactic antibiotics administration on colonized microorganisms of thoracic catheter inpneumothorax patients treated with closed thoracic drainage

作　　者：张黎[1] 刘锦铭[1] 史宏彰[1] 江平[1] 姜洪斌[1] 马俭[1] 陈宇[1] 

机构地区：[1]同济大学附属上海市肺科医院急诊科,上海200433

出　　处：《中华急诊医学杂志》2011年第3期287-291,共5页Chinese Journal of Emergency Medicine

摘　　要：目的研究气朐患者闭式引流术后胸管定植菌的病原学特点以及预防性抗生素应用在减少病原菌定植方面的意义。方法人组120例急诊留观的需接受胸腔闭式引流术治疗的气胸患者，随机（随机数字法）分为抗生素组（A组，n=60）和对照组（B组，n=60）完成胸腔置管术，术后A组给予甲磺酸左氧氟沙星氯化钠注射液0．6g／200mL·d^-1静脉滴注，B组给予0．9％氯化钠注射液200mL／d静脉滴注直至拔管后24h。拔管后将胸管前端2cm剪下行细菌培养。两组数据比较采用X^2检验或Fisher精确概率法。结果两组120例有49例导管培养阳性，共检出病原菌57株，位于前四位的病原菌分别是凝固酶阴性葡萄球菌（57．9％）、白色似丝酵母菌（10．5％）、金黄色葡萄球菌（7％）和鲍曼不动杆菌（7％），所有细菌对β-内酰胺类抗生素都具有较高的耐药率。有基础疾病的患者的导管细菌检出率（50％）高于单纯气胸患者的31％，两者差异具有统计学意义（P〈0．05）。置管时间超过14d的患者的导管细菌检出率（70％）明显高于置管14d以内的35％，两者差异具有统计学意义（P〈0．01）。置管小于7d时，A组导管的细菌检出率（8．3％）明显低于B组（52．9％），两者差异有统计学意义（P〈0．01）；置管7-14d时，A组导管的细菌检出率（21．4％）低于B组（68．8％），两者差异有统计学意义（P〈0．05）；置管大于14d时，两组导管的细菌检出率皆为70％，两者差异无统计学意义（P〉0．05）。两组患者在疾病转归和住院天数上差异无统计学意义（P〉0．05）。结论气胸患者闭式引流术后常见的胸管定植菌为条件致病菌，细菌耐药现象十分严重。置管时间的延长、患者合并基础疾病都会增加感染的风险。预防性的应用抗菌药物有利于减少短期置管（小于14d）患者的导管细菌检出率，降低�Objective To investigate the feature of the microorganisms colonization of the thoracic catheter-related infection and evaluate the clinical significance of prophylactic antibiotics administration in patients with pneumothorax treated with closed thoracic drainage. Method A total of 120 patients with pneumothorax treated with closcd thoracic drainage in emergcncy department were enrolled. The patients were randomized （random number） into group A （n = 60） and group B （n = 60）. In group A, the patients received levofloxacin mesylate injection and in group B, patients received physiological saline injection instead after closed thoracic drainage. The tip of catheter was cut off to get a 2-cm long segment after catheter removal and this segment was dipped into a bottle filled with liquid culture medium for microorganism cullure. Statistical analysis carried out by usingX^2 test or Fisher exact test. Results Of all 120 patients, microorganisms were found in 49 segments of catheter and 57 strains of microorganisms were found. The four most common microorganisms were Coagulase-negatiw; staphyloeocei （57.9%） , Candida albieans （10.5%） , Staphyloeoceus aureus （7%） and Aeinetobaeter baumanii （7%）. All of them were highly drug-resistant to [3-1actam antibioties. The difference in the positive rate of microorganism culture was distinct in pneumothorax patients with underlying diseases （50%） in comparison to the patients without underlying diseases （31%） （P 〈 0.05 ）. The positive rate of microorganism culture increased significantly as the duration of drainage was longer than 14 days （P 〈0.01 ）. The positive rate of culture in group A was lower than that in group B if the duration of drainage was less than 7 days （8.3% vs 52.9% , P 〈0.01 ）. The positive rate of euhure after drainage for 7 days was 21.4% in group A and 68.8% in group B （P 〈 0.05 ） , and that after drainage for over 14 days Was 70% in both groups （ P 〉 0.05 ）. There were no significant differenee

关 键 词：气胸 胸腔闭式引流术 导管定植菌 导管相关感染 预防性抗生素 

分 类 号：R561.4[医药卫生—呼吸系统]