成人急性脓胸的临床特征及病原学分析  

Clinical characteristics and pathogenic analysis of acute empyema in adults

作　　者：辛彩焕 熊辉[1] XIN Cai-huan;XIONG Hui(Emergency Department,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院急诊科,北京100034

出　　处：《中国临床药理学杂志》2025年第4期451-456,共6页The Chinese Journal of Clinical Pharmacology

基　　金：中央高水平医院临床科研业务费(北京大学第一医院青年临床研究专项基金)资助项目(2023YC17)。

摘　　要：目的分析成人急性脓胸的临床特征及病原学分布特点。方法将成人急性脓胸患者按队列法分为对照组(社区获得性脓胸患者)和试验组(医院获得性脓胸患者)。收集并比较2组患者的一般资料、临床表现、实验室检查、影像学资料、抗菌药物使用情况、有创治疗手段及结局转归。结果试验组入组59例,对照组入组102例。试验组与对照组相比,肺脓肿构成比更低(1.69%vs 10.78%,P<0.05),气胸构成比、脓液培养阳性率及混合感染占比更高(47.46%vs 18.63%、55.93%vs 24.51%、27.12%vs 1.96%,均P<0.05)。对照组脓液培养检出致病菌27株,以革兰氏阳性球菌为主(74.07%),咽峡炎链球菌群占比最高(44.44%);试验组检出52株,以革兰氏阴性杆菌为主(67.31%),铜绿假单胞菌占比最高(21.15%)。咽峡炎链球菌群对青霉素、头孢菌素均敏感;革兰氏阴性杆菌多重耐药率高,其中铜绿假单胞菌对美罗培南耐药率为69.23%。所有患者中有6例发生临床死亡,均属试验组、均属于非手术治疗患者,死因为恶性肿瘤或医院获得性肺炎。结论成人急性脓胸以非肺炎旁脓胸更常见,社区获得性脓胸和医院获得性脓胸的病原学分布存在显著差异。Objective To analyze the clinical characteristics and distribution of pathogens in adult acute empyema. Methods Adult patients with acute empyema were divided into the control group(patients with community-acquired empyema) and the treatment group(patients with hospital-acquired empyema) according to cohort method. The general data, clinical manifestations, laboratory examinations, imaging data, antimicrobial drugs use, invasive treatment and outcomes of the two groups were collected and compared. Results There were 59 cases in the treatment group and 102 cases in the control group. Compared with the control group, the proportion of lung abscess in the treatment group was lower(1.69% vs 10.78%,P<0.05),the proportion of pneumothorax, positive rates of pus culture and mixed infection were higher(47.46% vs 18.63%,55.93% vs 24.51%,27.12% vs 1.96%,all P<0.05). In the control group, 27 strains of pathogens were isolated, predominantly Gram-positive cocci(74.07%),with Streptococcus anginosus group being the most common(44.44%). In the treatment group, 52 strains were isolated, predominantly Gram-negative bacilli(67.31%),with Pseudomonas aeruginosa being the most common( 21. 15%). Streptococcus anginosus group was sensitive to penicilins and cephalosporins,while the multidrug resistance rate of Gram-negative bacilli was high,with Pseudomonas aeruginosa showing a 69. 23% resistance to meropenem. Six patients in total died,all from the treatment group and receiving non-surgical treatment,due to malignant tumors or hospital-acquired pneumonia. Conclusion In adult acute empyema,non-parapneumonic empyema is common,and there were significant differences in the pathogenic distribution between community-acquired empyema and hospital-acquired empyema.

关 键 词：脓胸 临床特征 病原学 

分 类 号：R978.1[医药卫生—药品]