120例慢性化脓性中耳炎患者耳道分泌物病原菌及治疗效果分析  

Distribution of pathogens isolated from ear canal secretions of 120 patients with chronic suppurative otitis media and curative effect

作　　者：胡铁阳[1] 李胜[2] 官建军[3] 唐有良[1] 刘学[1] 

机构地区：[1]常山县人民医院耳鼻咽喉科,浙江常山县324200 [2]衢州市人民医院耳鼻咽喉科,浙江衢州324000 [3]常山县人民医院检验科,浙江常山县324200

出　　处：《中华医院感染学杂志》2017年第10期2317-2320,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划基金资助项目(2012KYA189)

摘　　要：目的探讨120例慢性化脓性中耳炎患者耳道分泌物病原菌感染及抗菌治疗效果,为慢性化脓性中耳炎治疗提供参考。方法选取医院2014年1月-2016年6月接诊的120例慢性化脓性中耳炎患者,随机分为观察组和对照组,每组各60例,对照组患者给予常规治疗,观察组患者给予联合用药治疗;通过观察记录两组患者耳道分泌物培养病原菌构成及病原菌对抗菌药物的耐药性,比较两组患者的听力恢复情况、不良反应及临床治疗效果。结果 120耳耳道分泌物标本中,118耳培养出病原菌,细菌116耳,占98.30%,其中革兰阳性菌74株,占62.71%,革兰阴性菌42株,占35.59%;真菌2耳,占1.70%;观察病原菌的耐药性情况发现,革兰阳性菌和革兰阴性菌的耐药性有所不同,革兰阳性菌中葡萄菌属较为敏感的抗菌药物有头孢唑林、红霉素及奈替米星,革兰阴性菌中铜绿假单胞菌较敏感的抗菌药物有头孢他啶、万古霉素、头孢曲松及氨苄西林,革兰阳性菌与革兰阴性菌都较为敏感的药物是庆大霉素和环丙沙星;观察组听力改善率95.00%,高于对照组(81.67%),两组比较差异有统计学意义(P<0.05);观察组不良反应发生率为10.00%,明显低于对照组(23.33%),两组比较差异有统计学意义(P<0.05);观察组治疗总有效率91.67%,明显高于对照组(73.33%),两组比较差异有统计学意义(P<0.05)。结论慢性化脓性中耳炎的主要病原菌有金黄色葡萄球菌、表皮葡萄球菌和铜绿假单胞菌等,常用抗菌药种类繁多,不同病原菌耐药性不同,治疗时根据细菌培养和药敏结果用药,能够避免药物乱用,更准确安全的治疗。OBJECTIVE To explore the distribution of pathogens isolated from ear canal secretions of 120 patients with chronic suppurative otitis media and observe the effect of antimicrobial treatment so as to provide guidance for treatment of chronic suppurative otitis media.METHODS A total of 120 patients with chronic suppurative otitis media who were treated in the hospital from Jan 2014 to Jun 2016 were enrolled in the study and randomly divided into the observation group and the control group,with 60 cases in each group.The control group was given the conventional therapy,while the observation group was treated with combined drug therapy.The constituent ratios of the pathogens cultured from the ear canal secretions and the drug resistance rates of the pathogens were observed and recorded;the hearing recovery status,adverse reactions,and clinical curative effect were compared between the two groups of patients.RESULTS The pathogens were cultured from the ear canal secretions of 118 in 120 ears,the bacteria were cultured from 116 ears,accounting for 98.30%,including 74 （62.71%） strains of gram-positive bacteria and 42 （35.59%） strains of gram-negative bacteria;the fungi were cultured from 2 ears,accounting for 1.70%.The analysis of the drug resistance of the pathogens showed that the gram-positive bacteria and the gram-negative bacteria varied in the drug resistance;among the gram-positive bacteria,the Staphylococcus spp was highly susceptible to cefazolin,erythromycin and netilmicin;among the gram-negative bacteria,the Pseudomonas aeruginosa was highly susceptible to ceftazidime,vancomycin,ceftriaxone,and ampicillin.Both the gram-positive bacteria and gram-negative bacteria were susceptible to gentamicin and ciprofloxacin.The improvement rate of hearing of the observation group was 95.00 %,significantly higher than 81.67 % of the control group （P〈0.05）.The incidence of adverse reactions of the observation group was 10.00%%,significantly lower than 23.33% of the control group （P〈0.05）.The total effect

关 键 词：慢性化脓性中耳炎 病原菌 感染 抗菌治疗 

分 类 号：R378[医药卫生—病原生物学]