恶性中心气道狭窄患者金属支架置入后下呼吸道感染分析  

Incidence and etiology of lower respiratory tract infections in patients with malignant central airway obstruction after metal stent implantation

作　　者：陈令佳 李建民[1] 张卫东[1] 柳威[1] 谭建龙[1] 陈江川 刘志光[1] CHEN Lingjia;LI Jianmin;ZHANG Weidong;LIU Wei;TAN Jianlong;CHEN Jiangchuan;LIU Zhiguang(Department of Pulmonary and Critical Care Medicine,Hunan Provincial People's Hospital,The First Affiliated Hospital of Hunan Normal University,Changsha,Hunan 410005,P.R.China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)呼吸与危重症医学科,湖南长沙410005

出　　处：《中国呼吸与危重监护杂志》2022年第1期31-36,共6页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：卫生公益性行业科研专项(201402024);湖南省卫生健康委员会一般资助项目(202203023890)。

摘　　要：目的研究恶性中心气道狭窄(malignant central airway obstruction,MCAO)患者气道金属支架置入后下呼吸道感染(lower respiratory tract infection,LRTI)的发生率及病原学分布情况。方法回顾性分析2014年4月—2021年4月在湖南省人民医院呼吸与危重症医学科住院的149例行气道金属支架置入治疗的MCAO患者的临床资料。统计支架置入后LRTI发生率;根据术后是否发生LRTI分为感染组和未感染组,比较两组临床资料,分析LRTI发生的影响因素;采集LRTI患者痰液标本和(或)支气管肺泡灌洗液标本,行病原学检测及药敏试验,分析病原菌分布情况及主要病原菌耐药性。结果本研究共纳入149例行金属支架置入治疗的MCAO患者,LRTI发生率21.48%;感染组年龄大于未感染组,有吸烟史、有放化疗史、使用覆膜支架、有支架相关肉芽组织增生者占比高于未感染组,有术后规范雾化吸入者占比低于未感染组(P<0.05);年龄、吸烟史、放化疗史、支架类型为覆膜支架、支架相关肉芽组织增生、术后规范雾化吸入是影响MCAO患者发生LRTI的主要因素(P<0.05);32例LRTI患者共检出病原菌38株,革兰阴性菌、革兰阳性菌、真菌分别占比68.42%(26/38)、21.05%(8/38)、10.53%(4/38);主要革兰阴性菌铜绿假单胞菌对妥布霉素、庆大霉素、阿米卡星无耐药菌株,对复方新诺明、替加环素、氨苄西林耐药性较高;肺炎克雷伯菌对妥布霉素、阿米卡星、替加环素耐药性较低,对头孢噻肟、环丙沙星、头孢吡肟等耐药性均较高;主要革兰阳性菌金黄色葡萄球菌对万古霉素、利奈唑胺、复方新诺明、奎奴普丁/达福普汀无耐药菌株,对四环素、青霉素G、左氧氟沙星、苯唑西林、环丙沙星耐药性较高;主要真菌白色假丝酵母菌,药敏试验结果显示,其对氟康唑、伊曲康唑、伏立康唑、5-氟胞嘧啶、两性霉素B无耐药菌株;根据病原学检测及药敏试验结果选择抗�Objective To study the incidence and etiological distribution of lower respiratory tract infection(LRTI)after airway metal stent implantation in patients with malignant central airway obstruction(MCAO).Methods The clinical data of 149 patients with MCAO who underwent airway metal stent implantation in Department of Pulmonary and Critical Care Medicine of Hunan Provincial People’s Hospital from April 2014 to April 2021 were selected for a retrospective study.The incidence of LRTI after treatment was counted.According to whether LRTI occurred after operation,they were divided into infected group and uninfected group.The clinical data of the two groups were compared and the influencing factors of LRTI were analyzed.Sputum samples and/or bronchoalveolar lavage fluid samples from patients infected with LRTI were collected for pathogen detection and drug susceptibility test,and the distribution and drug resistance of main pathogens were analyzed.Results A total of 149 patients who met the criteria were included in this study and the incidence of LRTI was 21.48%.People in the infected group was older than that in the uninfected one,and the proportion of people with a history of smoking,chemoradiotherapy,covered metal stents,and stent-related granulation tissue proliferation was higher,and the proportion of people with postoperative standardized aerosol inhalation was lower(P<0.05).Age,smoking history,chemoradiotherapy,covered metal stents,stent-related granulation tissue hyperplasia and postoperative standardized aerosol inhalation were all influencing factors of LRTI in these patients(P<0.05).A total of 38 pathogens were detected in 32 patients with LRTI.Gram negative bacteria,gram positive bacteria and fungi accounted for 68.42%(26/38),21.05%(8/38)and 10.53%(4/38)respectively.Pseudomonas aeruginosa,the main Gram-negative bacteria,had no resistance to tobramycin,gentamicin and amikacin,but had high resistance to compound sulfamethoxazole,tigecycline and ampicillin;Klebsiella pneumoniae had low resistance to tobramyci

关 键 词：恶性中心气道狭窄 气道金属支架 下呼吸道感染 发生率 病原学 

分 类 号：R562.2[医药卫生—呼吸系统]