鼻腔消毒对经蝶窦入路鼻腔定植菌的影响  

Influence of Nasal Disinfection on Nasal Bacterial Colonization through the Transsphenoidal Approach

作　　者：刘小海[1] 金雨 郭晓鹏[1] 冯铭[1] 包新杰[1] 邓侃[1] 姚勇[1] 连伟[1] 杨启文[2] 王任直[1] 幸兵[1] LIU Xiaohai;JIN Yu;GUO Xiaopeng;FENG Ming;BAO Xinjie;DENG Kan;LIAN Wei;YANG Qiwen;WANG Renzhi;XING Bing(Depatment ofNeurosurgery;Department of LaboratmT Medicine,PUMC Hospital,CAMS and PUMC,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院神经外科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院检验科,北京100730

出　　处：《中国医学科学院学报》2018年第3期356-359,共4页Acta Academiae Medicinae Sinicae

基　　金：2016年协和中青年科研基金和大学生创新训练计划项目(2017zlgc0605)~~

摘　　要：目的评估络合碘鼻腔消毒对经蝶窦入路鼻腔定植菌的影响。方法以2017年1月至8月在北京协和医院神经外科行经蝶窦手术的133例垂体腺瘤患者为研究对象,消毒前采用咽拭子采集下鼻甲根部分泌物进行细菌培养,络合碘鼻腔消毒后再采用咽拭子对相同部位取样并行细菌培养,比较消毒前后鼻腔定植菌菌谱变化情况;术后随访观察3个月,记录患者颅内感染/菌血症的发生情况,分析其与鼻腔定植菌的相关性。结果 133例患者中,45例(33.8%)络合碘消毒前细菌培养发现定植菌,6例(4.5%)消毒后再培养发现同类型定植菌,消毒前后鼻腔定植菌阳性率差异有统计学意义(χ2=34.5,P=0.000);络合碘消毒能消灭86.7%(39/45)的鼻腔定植菌。鼻腔最常见的定植菌为金黄色葡萄球菌(24.4%,11/45)、肺炎克雷伯菌ESBL(-)(24.4%,11/45)、表皮葡萄球菌(13.3%,6/45)。1例患者于术后第2天发生高热寒战,但血培养和脑脊液培养均阴性,经三代头孢治疗2 d后症状消失,临床诊断为菌血症。结论鼻腔中存在定植菌,络合碘消毒鼻腔能有效杀灭大部分鼻腔定植菌,经蝶窦入路术后发生颅内感染/菌血症的可能性小。Objective To explore the influence of the iodine disinfection on nasal bacterial colonization through the transsphenoidal approach. Methods Totally 133 pituitary adenoma patients who underwent transsphenoidal surgery in our department from January to August 2017 were enrolled in this study. Before disinfection,pharyngeal swabs of inferior turbinate root secretions were taken for bacterial culture. After iodine disinfection,pharyngeal swabs were taken again at the same site. Changes in the nasal bacterial spectrum before and after disinfection were compared. Patients were followed up for three months after the surgery,during which any intracranial infection/bacteraemia was recorded, and its correlation with nasal bacteria colonization was analyzed.Results Nasal bacterial colonization was detected in 45（33. 8%） of 133 patients before iodine disinfection andin only 6 cases（4. 5%） after iodine disinfection（ χ2= 34. 5,P = 0. 000）. Thus,iodine disinfection eliminated 86. 7%（ 39/45） of the colonized bacteria. The most common nasal bacterium was Staphylococcus aureus（24. 4%,11/45）,followed by Klebsiella pneumoniae（24. 4%,11/45）,and Staphylococcus epidermidis（13. 3%,6/45）. One patient had high fever and chills 2 days after surgery,but blood culture and cerebrospinal fluid culture showed negative results. After the administration of third-generation cephalosporins,the symptoms disappeared after two days. Conclusions There are colonized bacteria in nasal cavity. Iodine disinfection of nasal cavity can effectively clear most of the nasal bacteria. The possibility of intracranial infection/bacteremia after transsphenoidal approach is low.

关 键 词：经蝶窦手术 碘伏消毒 鼻腔定植菌 菌血症 颅内感染 

分 类 号：R446[医药卫生—诊断学]