慢性鼻-鼻窦炎手术前后鼻腔细菌学研究及药敏试验分析  

Study on nasal bacteriology and drug sensitivity test of chronic rhinosinusitis before and after operation

作　　者：李春龙 詹晓东[1] Li Chunlong;Zhan Xiaodong(Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu,233000,China)

机构地区：[1]蚌埠医学院第一附属医院耳鼻咽喉头颈外科,233000

出　　处：《国际耳鼻咽喉头颈外科杂志》2021年第4期189-193,共5页International Journal of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨慢性鼻-鼻窦炎(CRS)患者手术前后鼻腔细菌感染状况的变化及药敏试验分析。方法实验组来自50例CRS患者术前中鼻道分泌物、鼻息肉组织和功能性内镜鼻窦手术术后1、3、6个月复诊时的中鼻道分泌物;对照组选取30例单纯鼻中隔偏曲或鼻出血患者的中鼻道分泌物。结果对照组与实验组术前、术后1个月及术后3个月中鼻道分泌物细菌检出率分别为63.3%、92.0%、94.0%、90.0%,组间比较差异具有统计学意义。对照组与实验组术后6个月中鼻道分泌物细菌检出率分别为63.3%和68.0%,无统计学差异。实验组术后6个月与术前、术后1个月及术后3个月中鼻道分泌物细菌检出率分别为68.0%、92%、94.0%、90.0%,组间有统计学差异。慢性鼻-鼻窦炎不伴鼻息肉与慢性鼻-鼻窦炎伴鼻息肉患者术前中鼻道分泌物细菌检出率分别为92.9%和90.9%,无统计学差异。慢性鼻-鼻窦炎伴鼻息肉患者鼻息肉组织细菌检出率为13.6%(3/22)。各组间革兰阳性菌、革兰阴性菌、厌氧菌构成比差异均无统计学意义。需氧菌对环丙沙星、复方新诺明和三代头孢(头孢曲松)敏感率较高,药物敏感率分别为94.6%(229/242)、84.7%(205/242)和81.4%(197/242);二代头孢(头孢呋辛)中等敏感,药物敏感率为74.0%(179/242),青霉素的敏感性低,药物敏感率为39.7%(96/242),厌氧菌(12株)最敏感的抗生素是万古霉素,其药物敏感率为91.7%(11/12)。结论细菌感染是引起CRS的重要因素,亦可能是引发鼻息肉的病因之一。功能性内镜鼻窦手术术后鼻腔、窦口引流通畅,手术可以减少细菌的生长,使鼻腔内细菌谱恢复至正常。手术可以减少细菌的生长,使鼻腔内细菌谱恢复致正常。CRS是否伴有鼻息肉对细菌的生长及革兰阳性菌、革兰阴性菌、厌氧菌的分布无重要影响。Objective To investigate the changes of nasal bacterial infection before and after surgery in patients with chronic rhinosinusitis(CRS)and analysis of drug sensitivity test.Methods The experimental group came from 50 CRS patients'intraoperative secretions of middle meatus,nasal polyp tissues and secretions of middle meatus at 1,3,6 months after functional endoscopic sinus surgery(FESS).Thirty patients with simple septal deviation or epistaxis were control group.Results The rate of bacterial detection in secretions of middle meatus was statistically significant between the control group(63.3%)and preoperation(92%),1 month(94.0%)and 3 months(90.0%)after operation in experimental group.There was no significant difference in bacterial detection rate in secretions of middle meatus between the control group(63.3%)and 6 months after operation in the experimental group(68.0%).The bacterial detection rates in secretions of middle meatus showed statistic differences in 6 mons postoperation(68.0%)compared with preoperation(68.0%),1 mon postoperation(94.0%),3 mons postoperation(90.0%)experimental groups.Chronic rhinosinusitis without nasal polyps(CRSsNP)group(92.9%)and chronic rhinosinusitis with nasal polyps(CRSwNP)(90.9%)showed no statistical significance in the preoperative bacterial detection rate in secretions of middle meatus.The bacterial detection rate was 13.6%(3/22)in nasal polyps of patients with CRSwNP.There were no statistically significant differences in the composition ratios of Gram-positive bacteria,Gramnegative bacteria and anaerobic bacteria among the groups.Aerobic bacteria was sensitive to ciprofloxacin,sulfamethoxazole and third generation cephalosporins(ceftriaxone),drug sensitivity rates were 94.6%(229/242),84.7%(205/242)and 81.4%(197/242),respectively.Second generation cephalosporin(cefuroxime)is moderately sensitive,and its drug sensitivity rate was 74.0%(179/242).The sensitivity to penicillin was very low,with a drug sensitivity rate of 39.7%(96/242).Vancomycin was the most sensitive antibiotic for

关 键 词：鼻窦炎 细菌 微生物敏感性试验 内窥镜检查 

分 类 号：R765.9[医药卫生—耳鼻咽喉科] R446.5[医药卫生—临床医学]