慢性鼻-鼻窦炎患儿鼻腔灌洗液病原学及腺样体切除术治疗效果  

Analysis on the etiology of nasal lavage fluid and the effect of adenoidectomy in children with chronic rhinosinusitis

作　　者：崔华 夏忠芳[1] 王淑芬 吴鹃 CUI Hua;XIA Zhong-fang;WANG Shu-fen;WU Juan(Wuhan Children's Hospital Tongji Medical College Huazkong University of Science and Technology,Wuhan,Hubei 430016,China;不详)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院耳鼻咽喉科,湖北武汉430016 [2]华中科技大学同济医学院附属武汉儿童医院药学部,湖北武汉430016

出　　处：《中华医院感染学杂志》2021年第16期2541-2545,共5页Chinese Journal of Nosocomiology

基　　金：武汉市自然科学基金资助项目(WX16C15)。

摘　　要：目的探讨慢性鼻-鼻窦炎(CRS)患儿鼻腔灌洗液病原菌分布、耐药性情况,并分析药物联合手术的治疗效果。方法选取华中科技大学同济医学院附属武汉儿童医院耳鼻咽喉科2018年9月-2020年1月收治的108例CRS伴腺样体肥大的患儿,随机分为试验组和对照组,各54例,所有患儿治疗前均收集鼻腔灌洗液进行病原菌培养鉴别和药敏试验,分析CRS患儿的鼻腔灌洗液病原菌分布及耐药情况。对照组给予抗菌药物、鼻用糖皮质激素及鼻腔冲洗、黏液溶解促排剂等治疗,试验组在对照组的基础上给予腺样体切除术,比较两组患者治疗14 d后,临床症状的视觉模拟评分(VAS)、鼻内镜评分、鼻窦CT评分。结果108例CRS患儿的标本中有91份标本细菌培养阳性,阳性率为84.26%;91份标本共分离出136株病原菌,其中革兰阳性菌80株占58.82%,以表皮葡萄球菌、草绿色链球菌为主,革兰阴性菌56株占41.18%,以产气肠杆菌、肺炎克雷伯菌为主;表皮葡萄球菌对青霉素G、红霉素耐药率高,对万古霉素敏感,产气肠杆菌对头孢唑林、庆大霉素耐药率高,对亚胺培南、头孢吡肟、头孢他啶敏感;两组患儿治疗后临床症状的VAS评分、鼻内镜评分、鼻窦CT评分均降低(P<0.05),且试验组患儿降低更显著(P<0.05)。结论CRS患儿鼻部感染以革兰阳性菌为主,应结合病原菌及耐药试验选用抗菌药物,同时联合腺样体切除术能进一步提高治疗效果。OBJECTIVE To explore the pathogenic distribution and drug resistance in nasal lavage fluid(NLF)of children with chronic rhinosinusitis(CRS),and to analyze the treatment curative effect of drugs combined with surgery.METHODS A total of 108 children with CRS and adenoid hypertrophy admitted to the Otolaryngology Department of Wuhan Children’s Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from Sep 2018 to Jan 2020 were enrolled as the research subjects.They were randomly divided into the observation group and control group,54 cases in each group.Before the treatment,NLF of all children was collected for pathogens culture identification and drug sensitivity tests.The distribution and drug resistance of NLF pathogens in CRS children were analyzed.The control group was treated with antibiotics,glucocorticoids,nasal irrigation,mucolytics and mucokinetic drugs,while the observation group was treated with adenoidectomy on basis of the treatment in the control group.The scores of visual analogue scale(VAS)of clinical symptoms,nasal endoscopy and sinus CT after 14 days of treatment were compared between the two groups.RESULTS Among the specimens from 108 CRS children,there were 91 cases(84.26%)with positive bacterial culture.Among the 91 specimens,there were 136 strains of pathogens,including 80 strains(58.82%)of Gram-positive bacteria(mainly on Staphylococcus epidermidis,Streptococcus viridans)and 56 strains(41.18%)of Gram-negative bacteria(mainly on Enterobacter aerogenes,Klebsiella pneumoniae).The drug resistance rates of S.epidermidis were high to penicillin G and erythromycin,but the strain was sensitive to vancomycin.E.aerogenes were resistant to cefazolin,ampicillin and gentamicin,and sensitive to imipenem,cefepime and ceftazidime.After the treatment,scores of VAS,nasal endoscopy and nasal sinus CT in both groups were significantly decreased(P<0.05),and those in observation group decreased more significantly(P<0.05).CONCLUSION The pathogen in nasal infection in CRS p

关 键 词：慢性鼻-鼻窦炎 儿童 病原菌分布 腺样体切除术 

分 类 号：R765[医药卫生—耳鼻咽喉科]