作者：王永興，曹家月，郭梅，謝柏梅，劉德江，劉振霞

【關(guān)鍵詞】 ，肺

【Abstract】 AIM: To analyze the distribution of pathogens in respiratory tract and their drug resistance in the patients with acute explosion chronic obstructive pulmonary disease (AECOPD) for a better use of antibiotics in treatment. METHODS: The sputum samples of 240 AECOPD patients from January 2002 to May 2004 were collected from our hospital and the pathogens species in all samples were tested. The drug sensitivity was determined by slip diffusion method. RESULTS: 114 strains of pathogens were found in all sputum samples. 66.7% of them were Gramnegative， 24.6% were Grampositive and 7.0% were epiphytes. Among the Gramnegative bacillis， the main pathogens included Pseudomonas (28.1%)， Haemophilus influenza (15.8%)， enteric bacilli (12.3%)， and Klebsiella pneumoniae (8.8%). Among the Grampositive coccis， the main pathogens included Staphyloccus aureus (12.3%)， Pneumococcus (7.0%) and Staphyloccus epidermindis (5.3%). The results of drug sensitivity test showed that most of the Gramnegative bacillis were more sensitive to ticarcilli/clavulanate potassium， imipenem， ceftazidime， piperacillin and amikacin， and that most of the Grampositive coccis were more sensitive to imipenem， ceftazidime and vancomycin. CONCLUSION: Gramnegative bacillus are predominant in lower respiratory tract in AECOPD patients with higher frequency of drug resistance. The 3rd or 4th generation of cephalosporins and some antibiotics with the capability of inhibiting ESBLS are recommended in clinical application. 【Keywords】 lung diseases， obstructive; acute disease; chronic disease; pathogen， drug resistance， microbial 【摘要】 目的： 總結(jié)我院慢性阻塞性肺病急性加重期呼吸道感染病原菌分布和耐藥性特點(diǎn)，指導(dǎo)抗生素應(yīng)用. 方法： 對(duì)我院200201/200405呼吸病房及干部病房收治的240例AECOPD患者行痰液細(xì)菌培養(yǎng)，藥敏采用紙片擴(kuò)散法. 結(jié)果： 240例AECOPD患者痰細(xì)菌培養(yǎng)分離出114株致病菌，以革蘭陰性桿菌占首位（66.7%），革蘭陽性球菌第2位（24.6%），真菌第3位（7.0%）. 革蘭陰性桿菌中以假單胞菌屬（28.1%）、流感嗜血桿菌（15.8%）、腸桿菌屬（12.3%）、肺炎克雷伯桿菌（8.8%）為主要致病菌. 革蘭陽性球菌中以金黃色葡萄球菌（12.3%）、肺炎鏈球菌（7.0%）、表皮葡萄球菌（5.3%）為主要致病菌. 藥敏發(fā)現(xiàn)，替卡西林/克拉維酸、亞胺培南、頭孢他啶、哌拉西林、丁胺卡那對(duì)大部分革蘭陰性桿菌有較好敏感性，亞胺培南、頭孢他啶、萬古霉素對(duì)大部分革蘭陽性球菌有較好敏感性. 結(jié)論： AECOPD下呼吸道致病菌以革蘭陰性桿菌為主，且耐藥率較高. 經(jīng)驗(yàn)用藥宜選頭孢3， 4代或含有β內(nèi)酰胺酶抑制劑的抗生素. 【關(guān)鍵詞】 肺疾病，阻塞性；急性病；慢性病；病菌；抗藥性，微生物 0引言 慢性阻塞性肺病急性加重期（acute explosion chronic obstructive pulmonary disease， AECOPD）在臨床上極為常見，已經(jīng)成為周圍呼吸功能衰竭的主要原因. 其病原菌構(gòu)成較復(fù)雜，且隨著抗生素、糖皮質(zhì)激素的濫用，細(xì)菌耐藥現(xiàn)象日趨嚴(yán)重，給治療帶來很大困難. 為了解AECOPD下呼吸道感染病原菌分布和耐藥性特點(diǎn)，指導(dǎo)抗生素應(yīng)用，我們對(duì)我院呼吸科病房及干部病房AECOPD患者行痰細(xì)菌培養(yǎng)及藥敏試驗(yàn)，結(jié)果分析報(bào)道如下. 1對(duì)象和方法 1.1對(duì)象 我院200201/200405呼吸病房及干部病房收治的AECOPD患者240(男165，女75)例. 年齡51～89（平均62.8）歲，均符合中華呼吸學(xué)會(huì)1997年制定的COPD診斷標(biāo)準(zhǔn)，且有新近發(fā)生的痰量增加、膿性痰增多和呼吸困難加重，符合AECOPD. 其中合并糖尿病38例，合并慢性腎功能不全15例. 以AECOPD入院182例，以其他疾病入院，院內(nèi)發(fā)生AECOPD 58例. 1.2方法 在應(yīng)用抗生素前或抗生素療效差時(shí)行痰培養(yǎng). 患者晨起清水及30 mL/L雙氧水漱口，用力深咳第1口痰棄去，留第2口痰于無菌瓶中，1 h內(nèi)接種到羊血平板和巧克力平板，CO2孵箱35℃孵育. 以痰涂片光鏡檢查每低倍視野鱗狀上皮細(xì)胞<10個(gè)，白細(xì)胞>25個(gè)，或鱗狀上皮細(xì)胞/白細(xì)胞<1/2.5者為合格標(biāo)本. 按常規(guī)分離培養(yǎng)，遵循《全國臨床檢驗(yàn)操作規(guī)程》. 連續(xù)2次培養(yǎng)為同一細(xì)菌，即為可靠致病菌. 藥敏測定采用國際標(biāo)準(zhǔn)KirbyBaver紙片擴(kuò)散法，按美國NCCLS標(biāo)準(zhǔn)判定.