53例肠伤寒穿孔的细菌学与诊治

Bacterilogy and Management in 53 Cases with Abdominal Typhus Perforation

53例手术证实肠穿孔患者每例都有一种以上诊断指标确诊为伤寒.腹腔脓液需氧菌培养50例(94.34%),阳性率100%,主要是大肠杆菌(100%)、伤寒杆菌(78%);厌氧菌培养25例(49.15%),主要是脆弱类杆菌(88.89%).肠伤寒穿孔是多种细菌的混合感染,既有一般胃肠穿孔的特点,又有伤寒杆菌感染的特征性改变.丁胺卡那霉素对伤寒杆菌与大肠杆菌的药敏率分别为95.26%和94.52%,与甲哨唑联合应用,临床效果满意.肠伤寒穿孔的特征性改变有助于术中诊断.手术除处理肠穿孔外,主要目的是消除有利于厌氧菌生长的环境.常规营养支持可增强机体抗感染能力,提高治疗效果.本组治愈48例(90.56%),死亡5例(9.44%).

The every case of 55 patianis with intestine periorction has at least one marker to diagnose typhus. The aerobes of abdominal cavity in the 50(94.34%) patients were cultured, positive rate is 100%. The major bacteria are colon bacillus (100%), eberth's bacillus (78%). The anaerobes of abdominal cavity in the 25 (49.15%) patients were caltured, the major bacteria are bacteroides fragilis (75%). Abdominal typhus perforation is a kind of infection which anarobes and aerobes mixed. Not only has specificity of the general gastroenteric perforation but aslo has specificity of the eberth' s bacillus infection. The sensitivity rate of amikacin to eberth's bacillus and colon bacillus is the 96.26% and 94.52 % respectively, the combination of amikacin and metronidazole obtained satisfying effect on the clinical treatmet. The specific change of abdominal typhus of eberth s bacillus infection is a great help to diagnosis of abdominal typhus perforation in the operation. The major purpose of operation is to clear away enviroment which helping reproduction of the anaerobes, excpt for management of the enteric perforation. The routine nutritional support may strengthen ability to resist infection, and improve effect of the teat-ment. Of the 53 cases, 48 patients were recovered (94.56%), 2 patients died(9.44%).