慢性阻塞性肺疾病急性发作期细菌学分析与病情评估

Bacteriological analysis and condition assessment on acute exacerbations of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病急性发作期(AECOPD)细菌的检出情况与患者病情严重程度之间关系。方法对104例AECOPD患者的痰培养及药敏结果进行统计分析。所有患者均进行急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评价。结果痰标本中共分离出84株致病菌,其中主要为革兰阴性杆菌(61.90%),其中铜绿假单胞菌占21.43%,大肠埃希菌占8.33%,克雷伯杆菌占7.14%;革兰阳性菌(21.43%)中金黄色葡萄球菌占7.14%,肺炎链球菌占2.38%,表皮葡萄球菌占2.38%;真菌占16.67%。真菌组的患者APACHEⅡ积分均显著高于革兰阳性菌组和革兰阴性杆菌组差异均有统计学意义(P<0.01)。结论AECOPD呼吸道感染仍以细菌为主,但真菌感染有所增多。真菌感染的患者病情严重性明显增加。

Objective To explore the relation between bacterial infections and severity of acute exacerbation of chronic obstructive pulmonary disease（COPD）. Methods Sputum culture results and drug sensitivity results in 104 cases patients with acute exacerbation of COPD were analyzed. All of patients carried out APACHE Ⅱ integrating. Results 84 strains of pathogens were found in all sputum samples. 61.9% of them were Gram-negative. 21.43% were Gram-positive and 16.67% were fungi. Among the Gram-negative bacilis, the main pathogens included pseudomonas （21.43%）, enteric bacilli （8.33%） and klebsiela pneumoniae （7. 14% ）. Among the Gram-positive coccis, the main pathogens included staphyloccus aureus （7.14%）, pneuuloeoccus （ 2.38% ）, staphyloccus epidemfindis （ 2.38% ）, respectively. APACHE Ⅱ accumulated points in patients with fungi infections were higher than that in patients with Gram-positive coccis infections. APACHE Ⅱ accumulated points in patients with fungi infections were higher than that in patients with Gram-negative bacilis infections（ P 〈 0.01 ）. Conclusion The most organisms in respiratory tract infection was bacterium, but the opportunity of fungal infection raised. The severity of the fungal infection significant increased.