慢性阻塞性肺病急性恶化合并呼吸衰竭患者肺部微生物变化研究

The Changes of Lung Microbial in Patients with Acute Exacerbation of COPD with Respiratory Failure

目的:探究慢性阻塞性肺病急性恶化合并呼吸衰竭患者肺部微生物变化。方法:收集我院收治的慢性阻塞性肺疾病急性恶化合并呼吸衰竭患者182例,取患者痰液标本接种于血平板、麦康凯平板、巧克力平板和沙保罗平板,检测患者的耐药性以及肺部微生物连续性变化。结果:(1)以革兰阴性菌为主,革兰阳性菌以及真菌成分较多,其微生物构成比例呈逐渐上升趋势(P<0.05);(2)铜绿假单胞菌中,四环素类药物耐药率呈下降趋势(P<0.05);丁胺卡那霉素、碳青霉烯类、盐酸左氧氟沙星、哌拉西林他唑巴坦以及头孢哌酮舒巴坦等耐药率呈上升趋势(P<0.05);(3)治鲍曼氏不动杆菌对常用抗生素、碳青霉烯类、头孢他啶以及氨曲南的耐药率呈上升趋势(P<0.05);对头孢哌酮舒巴坦药物呈下降趋势(P<0.05);(4)肺炎克雷伯菌对庆大霉素、碳青霉素类、β-内酰胺酶抑制剂联合制剂以及三代头孢类等药物的耐药率呈上升趋势(P<0.05);对哌拉西林他唑巴坦药物呈下降趋势(P<0.05)。(5)大肠埃希菌对大部分常用药物耐药率呈上升趋势(P<0.05);对头孢吡肟以及氨曲南的耐药率呈下降趋势,(P<0.05);(6)金黄色葡萄球菌对常用抗生素以及大部分药物耐药率呈上升趋势,(P<0.05);对克林霉素以及复方新诺明的耐药率呈下降趋势,(P<0.05)。结论:慢性阻塞性肺病急性恶化合并呼吸衰竭患者肺部微生物连续性变化对慢阻肺急性恶化合并呼吸衰竭病情发展以及治疗具有诊断意义。

Objective： To investigate the effect on the changes of lung microbial in patients with acute exacerbation of chronic obstructive pulmonary disease（ COPD） with respiratory failure. Methods： 182 patients with acute exacerbation of COPD with respiratory failure from our hospital were selected. The sputum specimens were inoculated on blood plate,Jimmy Kang Kai,flat plate and flat sandy Paull chocolate. The drug resistance and changes of lung microbial continuity were tested and compared. Results： Gram-negative bacteria were the main bacteria,Gram-positive bacteria and fungi were more,and the proportion of microorganisms was gradually increasing（ P〈0. 05）. The resistance rate of tetracycline in Pseudomonas aeruginosa showed a downward trend（ P〈0.05）. The drug resistance rate of amikanamycin,carbapenems,levofloxacin,piperacillin tazobactam and cefoperazone sulbactam increased（ P〈0.05）. The resistance rates of the treatment of Bauman ＇s Acinetobacter to common antibiotics,carbon-and-resistant strains,and the resistance rates of the drug to the south of the Bacillus were higher,（ P〈0.05）. The resistance rate of Klebsiella pneumoniae to gentamicin,carbapenem,beta lactamase inhibitor and three generation cephalosporins increased（ P〈0. 05）.There was a downward trend in piperacillin tazobactam（ P〈0.05）. Escherichia coli was the most common drug resistance rate was on the rise,（ P〈0.05）. The resistance rate of the drug in the south of the drug and the resistance of the ammonia to the south of the ammonia was decreased（ P〈0.05）. Staphylococcus aureus s a rising trend in the use of antibiotics and most of the drug resistance rate,（ P〈0.05）. Clindamycin resistance and SMZ-TMP rate decreased（ P〈0.05）. Conclusion： The continuous changes in lung microbes in patients with acute exacerbation of COPD and respiratory failure have diagnostic significance for the development of acute exacerbation of COPD,the development of respiratory failure and the treatment of respiratory failure.