【摘要】 目的了解慢性阻塞性肺疾病急性加重(AECOPD)患者痰液病原体的分布特征,探讨其与动脉血氧分压(PaO2)和二氧化碳分压(PaCO2)的关系,以指导临床经验性抗感染治疗。方法 2008年12月—2010年3月入住大连医科大学附属第一医院呼吸科共有214例AECOPD患者,有184例患者采集到合格痰标本,进行痰培养及细菌鉴定,同时行血气分析检测。结果收集到合格痰标本的184例患者中,痰培养共检出56株致病病原体,培养阳性率为30.4%。56株病原体中,革兰阴性菌34株(占60.7%),其中非发酵菌16株(占28.6%);革兰阳性菌8株(占14.3%);真菌14株(占25.0%)。痰培养阳性组的PaO2水平低于痰培养阴性组〔分别为(63±25)mm Hg和(74±18)mm Hg〕,差异有统计学意义(P<0.05);痰培养阳性组的PaCO2水平高于痰培养阴性组〔分别为(60±19)mm Hg和(48±14)mm Hg〕,差异有统计学意义(P<0.05)。痰培养阳性组患者进行机械通气治疗的比例高于痰培养阴性组〔分别为28.6%(16/56)和6.2%(8/128)〕,差异有统计学意义(P<0.05)。结论本地区住院AECOPD患者的痰液病原体以革兰阴性菌为主,痰培养阳性患者通气和换气功能障碍进一步加重。更多还原

【Abstract】 Objective To investigate the distributive characteristic of strains isolated from the sputum of patients with acute exacerbations of chronic obstructive pulmonary disease( AECOPD),and to study its correlation with arterial partial pressure of oxygen( PaO2) and carbon dioxide( PaCO2) of the patients,so as to guide the clinical treatment of empirical anti- infection. Methods Among all the 214 AECOPD inpatients admitted,from Dec 2008 to Mar 2010,in the Department of Pulmonary Medicine,the First Hospital of Dalian Medical University,there were 184 patients from whom the qualified sputum specimens were collected for conventional culture and identification of bacteria. PaO2and PaCO2level of these patients were simultaneously tested. Results A total of 56 trains of bacteria were isolated from the 184 sputum specimens,the positivity rate of sputum culture was 30. 4%. Among them 34 strains( 60. 7%) isolated were Gram- negative bacilli,including 16 strains( 28. 6%) of non- fermenter bacilli; 8( 14. 3%) were Gram- positive cocci; and 14( 25. 0%) were fungi. The level of PaO2in the positivity group of sputum culture was( 63 ± 25) mm Hg,being lower than( 74 ± 18) mm Hg in the negativity group( P < 0. 05); but the level of PaCO2in the positivity group was( 60 ± 19) mm Hg,being higher than( 48 ± 14) mm Hg in the negativity group( P < 0. 05).The ratio of mechanical ventilation in the positivity group was 28. 6%( 16 /56),being significantly higher than 6. 2%( 8 /128)in the negativity group( P < 0. 05). Conclusion Pathogens of inpatients with AECOPD are mainly Gram- negative bacilli in our area. The dysfunction of pulmonary ventilation in patients with positivity of sputum culture is more serious.更多还原