根据痰液性状判断下呼吸道感染患儿病原菌及选择抗生素的临床研究  

Clinical research of determination of infection status of children with lower respiratory infection according to sputum properties and the accuracy of the choice of antibiotics

作　　者：李仲霞 冉建瑜 梁飞雁 黄华 梁驰 黎德郡 Li Zhongxia;Ran Jianyu;Liang Feiyan;Huang Hua;Liang Chi;Li Dejun(Department of Pediatrics,Wuzhou Workers Hospital,the Seventh Hospital Affiliated to Guangxi Medical University,Wnzhou,Guangxi 543000,China;Department of Clinical Laboratory,Wuzhou Workers Hospital,the Seventh Hospital Affiliated to Guangxi Medical University,Wuzhou,Guangxi 543000,China)

机构地区：[1]广西医科大学第七附属医院梧州市工人医院儿科,543000 [2]广西医科大学第七附属医院梧州市工人医院检验科,543000

出　　处：《中国基层医药》2020年第8期927-931,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题(82015137);广西壮族自治区梧州市科学研究与技术开发计划项目(201502096)。

摘　　要：目的探讨根据痰液性状初步判断下呼吸道感染患儿病原菌及选择相应抗生素的准确性,分析患儿年龄、入院前病程、住院时间等与痰培养阳性率、多重耐药率的相关性。方法选择广西医科大学第七附属医院(梧州市工人医院)2015年3月至2016年11月收治的下呼吸道感染患儿300例为观察对象,经鼻取患儿下呼吸道痰液记录其性状并进行细菌培养,记录入院初期及住院3~4 d后抗生素调整情况,分析年龄、住院时间等对疾病恢复的影响。结果300例下呼吸道感染患儿中,痰培养阳性110例,主要病原菌为肺炎链球菌、大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯杆菌肺炎亚种。与痰培养阳性者比较,黏白痰及黏黄痰组,痰培养阴性者初次用药准确率高(黏白痰64.4%,黏黄痰57.1%),差异有统计学意义(χ2=36.04,P<0.01)。入院前病程长短在病原菌阳性率、多重耐药率方面差异无统计学意义(P>0.05),但住院时间长短在病原菌阳性率(住院时间≤7 d为24.7%,住院时间>7 d为48.1%,χ2=17.66)、多重耐药率(住院时间≤7 d为13.9%,住院时间>7 d为35.1%;χ2=5.40)方面差异均有统计学意义(均P<0.05)。不同年龄组的病原菌阳性率差异有统计学意义(1~6个月组48.1%,>6~36个月组28.3%,>36个月组25.0%,χ2=13.64,P<0.05)。结论抗生素使用准确率与痰液性状及痰培养结果有关,黏白痰及黏黄痰组的痰培养阴性者初次用药准确率高,一旦明确病原菌,更换敏感抗生素的概率增加。病原菌阳性率和多重耐药率与住院时间、患儿年龄有一定的关系。Objective To explore the accuracy of determination of the pathogen in children with lower respiratory infection according to sputum properties and the selection of corresponding antibiotics.To analyze the relationship between children's age,length of hospital stays and sputum culture positive rate.Methods From March 2015 to November 2016,300 children with lower respiratory infection in the Seventh Affiliated Hospital of Guangxi Medical University were selected.The isolated sputums through the nasal cavity were cultured,the sputum properties and antibiotics used at the beginning and 3-4 days later(after sputum culture)were recorded.Results The sputum culture showed that 110 of 300 cases with lower respiratory infection were positive.Main pathogens were streptococcus pneumoniae,E.coli,staphylococcus aureus,klebsiella pneumoniae subspecies.Compared with the children with positive sputum culture,for white phlegm sputum and yellow phlegm sputum,the children with sputum culture negative had higher accuracy of antibiotic use(white phlegm sputum:64.4%,yellow phlegm sputum:57.1%),the difference was statistically significant(χ2=36.04,P<0.01).The bacteria positive rate and multiple resistance rate had no statistically significant differences in length of treatment time prior to admission(all P>0.05).However,the bacteria positive rate(hospital stay≤7 d:24.7%,hospital stay>7 d:48.1%,χ2=17.66)and multiple resistance rate(hospital stay≤7 d:13.9%,hospital stay>7 d:35.1%;χ2=5.40)had statistically significant differences in the length of hospitalization(all P<0.05).The bacteria positive rates in different age groups were as follows:1-6 months:48.1%,>6-36 months:28.3%,>36 months:25.0%.Compared with the two others,the positive rate of 1-6 months was higher and had statistically significant difference(χ2=13.64,P<0.05).Conclusion Accuracy of antibiotics use has a certain relationship with sputum color or properties and the result of sputum culture,for white phlegm sputum and yellow phlegm sputum,the accuracy of antibiotics use

关 键 词：痰 数量性状 颜色 呼吸道感染 集落计数 微生物 抗菌药 时间因素 儿童 

分 类 号：R72[医药卫生—儿科]