慢性鼻窦炎病原学变迁的研究

Changes of etiology of chronic sinusitis

目的:了解慢性鼻窦炎病原学分布的变迁。方法:术中收集2010年全年111例(实验组)上颌窦或筛窦脓性分泌物,分别进行需氧菌和真菌培养,同时以30例健康受试者作为对照组,其培养结果与2005年的各种数据比较,分析病原微生物的分布变化。结果:实验组共培养出15种病原微生物,主要为肺炎克雷伯菌、甲型链球菌、鲍曼不动杆菌、表皮葡萄球菌、铜绿假单胞菌、白色念珠菌等;需氧菌和真菌培养阳性率为81.8%,其中革兰阳性菌37.8%,革兰阴性菌54.4%,各种真菌7.8%;对照组检测出表皮葡萄球菌、流感嗜血杆菌、甲型链球菌、卡他布兰汉菌和金黄色葡萄球菌5种细菌,与实验组比较差异有统计学意义(χ2=0.009,P<0.01);与2005年数据(革兰阳性菌56.3%,革兰阴性菌43.7%,真菌阳性率1.4%)比较,其分布特征有明显差异。结论:细菌感染是慢性鼻窦炎的重要原因之一;细菌分布结构从原来的革兰阳性菌变成现在的以革兰阴性菌为主,真菌感染也不容忽视。应用抗生素治疗宜先进行细菌培养与药敏试验。

Objective：To explore etiology distribution changes of chronic nasosinusitis.Method：The purulent discharges taken from the maxillary sinus and posterior ethmoid sinus of 111 patients during endoscopic sinus surgery were cultured for both bacteria and fungi as experimental group.In the control group,the discharges of the nasal cavity from 30 healthy adults were also cultured for bacteria.The culture results were compared with data of 2005,and changes in the distribution of pathogenic microorganisms were analyzed.Result：Fifteen species,including Klebsiella pneumoniae,Streptococcus viridans,Acinetobacter baumannii,Staphylococcus epidermidis,Pseudomonas aeruginosa and Candida albicans,were cultured from the testing group.The total positive rate of bacteria was 81.8%.The detectable rates of Gram-positive bacteria,Gram-negative bacteria,and various fungi were 37.8%,54.4%,7.8% respectively.Five species including Staphylococcus epidermidis,Haemophilus influenzae,Streptococcus viridans,Branhamella catarrhalis and Staphylococcus aureus etc were cultured from the control group.There was significant differences between 2005 and 2010 in experimental group（χ2=0.009,P0.01）.Conclusion：Bacterial infection is a major reason for chronic sinusitis.The bacteria distribution structure changed from the original gram-positive bacteria to gram-negative bacteria.Fungal infections can not be ignored.To bacteria culture and drug sensitivity test should be done before antibiotic treatment.