AECOPD致呼衰急诊气管插管病原学及耐药性探析.doc

AECOPD致呼衰急诊气管插管病原学及耐药性探析 　　【摘要】 目的：分析慢性阻塞性肺病加重（AECOPD）致呼衰急诊患者的病原学特征和耐药情况，指导初始经验性用药。方法：收集笔者所在医院92例因AECOPD致呼衰行急诊气管插管患者的气道痰液标本，进行细菌学培养及药敏试验。结果：92例患者共送检184份，分离出病原菌162株，其中革兰氏阴性杆菌108株，主要为大肠埃希菌，肺炎克雷伯杆菌，不动杆菌，铜绿假单胞菌，对第三代头孢菌素，氨基糖甙类和喹喏酮类有较高的耐药性，革兰氏阳性菌26株，主要为金黄色葡萄球菌，肺炎链球菌，表皮葡萄球菌，肠球菌。真菌28株。结论：AECOPD致呼衰需急诊气管插管的患者应选择强有力的抗菌药物，特别要注意细菌耐药及真菌感染 【关键词】 慢性阻塞性肺病加重； 急诊气管插管； 病原学； 耐药性 doi：10.14033/j.cnki.cfmr.2016.31.091 文献标识码 B 文章编号 1674-6805（2016）31-0161-02 【Abstrat】 Objective：To analyze the pathogens and drug-resistance in patients with emergency intubation due to respiratory failure caused by AECOPD，so as to guide clinical rational administration.Method：The sputum of 92 patients was collected at the same time in tracheal intubation，the bacteria were cultured，and then the drug sensitivity was analyzed.Result：162 strains were isolated from 184 sputum samples including 108 Gram-negative bacillis and 26 Gram-positive cocci and 28 strains of fungi.The mainly gram-negative bacilli were Escherichia coli，klebsiella pneumoniae， pseudomonas aeruginosa and acinetobacter.They had a high drug resistance to the third-generation cephalosporin，quinolones and amino sugar glucoside class antibiotic.The mainly gram-positive cocci were staphylococcus ball，the fungal infection rate showed an increasing tendency.Conclusion：For respiratory failure patients with emergency intubation caused by AECOPD， We should use powerful antibiotics to control the infection as soon as possible.Special attention should be paid to bacterial resistance and fungal infections. 【Key words】 AECOPD； Emergency intubation； Pathogenic bacteria； Drug-resistance First-authors address：The Peoples Hospital of Binhai County，Binhai 224500，China AECOPD患者常在院前反复就诊于各级医疗机构或在医疗相关机构（养老院，社区诊所）实施治疗，入院时因感染已发生严重呼吸衰竭，需急诊气管插管，此时抗菌药物的选择应用对患者的治疗效果，预后，经济负担等有着直接的影响。为此对笔者所在医院2015月1月-2016年7月AECOPD致呼衰行急诊气管插管患者留取的气道痰液标本作细菌培养和药敏试验，了解病原菌种类及耐药情况，为临床治疗提供参考 1 资料与方法 1.1 一般资料 选择笔者所在医院2015年1月-2016年7月因AECOPD致呼衰行急诊气管插管患者92例[1]，其中男79例，女13例，平均年龄71岁，入院