老年人气管插管和气管切开患者绿脓杆菌对多种抗生素耐药比较

[文章编号]100521139(2002)022*******

老年人气管插管和气管切开患者绿脓杆菌对多种抗生素耐药比较

刘长庭,秦　荧,王德龙

(解放军总医院南楼呼吸科,北京　100853)

[摘要]　目的:比较老年人气管插管和切开患者绿脓杆菌对多种抗生素耐药。方法:45例气管插管期间痰培养的99株绿脓杆菌对多种抗生素耐药与40例气管切开期间痰培养的264株绿脓杆菌对多种抗生素耐药进行比较。结果:气管切开患者绿脓杆菌对抗生素耐药比气管插管患者绿脓杆菌对抗生素耐药有所增加,其中丁胺卡那霉素、环丙沙星、磺苯咪唑青霉素、羧噻吩青霉素、妥布霉素耐药增加有显著统计学意义(P<0105,P<0101);其他抗生素如氨曲南、羧苄青霉素、替门汀、头孢哌酮钠耐药也有所增加,未达到统计学意义。绿脓杆菌对头孢他啶及亚胺培南耐药变化不大。结论:老年人气管切开患者绿脓杆菌对丁胺卡那霉素、环丙沙星、磺苯咪唑青霉素、羧噻吩青霉素、妥布霉素耐药率比气管插管患者的耐药率增加,对头孢他啶及亚胺培南耐药变化不大。

[关键词]插管法,气管内;气管切开术;细菌感染;假单胞菌,铜绿

[中图分类号]R563 [文献标识码]A

Comparative of drug2resistant of pseudomonas aeruginosa in the elder patients with tracheal cannula and incision

LIU Chang2ting,QIN Ying,WANG De2long(Respiratory department o f south building,P LA G eneral Hospital, Beijing,100853,China)

[Abstract]　Objective:C ompared of drug2resistant of pseudom onas aeruginosa in the elder patients with tracheal cannula and incision1 Methods:99strains drug sensitivity tests of pseudom onas aeruginosa in the elder patients with45cases tracheal cannula compared with 264strains drug sensitivity in the elder patients with40cases tracheal incision1R esults:Drug2resistant of pseudom onas aeruginosa in the elder patients with tracheal incision compared with tracheal cannula was increase1The drug2resistant rates of amikacin,ciprofloxacin, meziocillin,ticarcillin,tobramycin were increase significantly in the patients with tracheal incision compared with tracheal cannula1The drug2resistant rates of aztreonam1carbenicillin,timentin and cefoperazone were increasing too,but it was no significantly1Drug2resistant rates of pseudom onas aeruginosa for ceftazidime and impenem were not changes1Conclusion:Drug2resistant rats of pseudom onas aerugi2 nosa were increasing in the elder patients with tracheal incision compared with tracheal cannula,but drug2resistant rates of pseudom onas aeruginosa for ceftazidime and impenem were not changes1

[K ey w ords]intubation,intrabronchial;tracheotomy;bacterial in fections;pseudom onas aeruginosa

老年慢性阻塞性肺疾病(C OPD)患者常因肺部感染而诱发呼吸衰竭,重症呼吸衰竭救治往往需要气管插管和/或气管切开及机械通气,气管插管和气管切开患者绿脓杆菌是呼吸道反复感染的重要致病菌,长期用抗生素治疗绿脓杆菌往往对多种抗生素耐药,给临床治疗带来了很大困难。但在气管插管和气管切开患者绿脓杆菌对抗生素耐药是否会有不

[收稿日期]2001211227 [修回日期]2001212220

[作者简介]刘长庭(19542),男(汉族),安徽省六安市人,1978年毕业于上海第二军医大学,主任医师、教授,博士生导师,发表论文100余篇,获全军医疗、科技进步一、二等奖三项。电话:(010) 66937631同,这是临床医务工作者在选用抗生素时所关心的问题。笔者分析比较了45例气管插管期间痰培养99株绿脓杆菌耐药及40例气管切开患者痰培养的264株绿脓杆菌耐药情况,提供给广大的临床医师在遇到类似患者时选用抗生素参考。

1　对象和方法

111　临床资料　气管插管45例,均因C OPD伴发肺部感染,诱发急性呼吸衰竭,最后行气管插管,气管插管时间为3～90d,45例均为男性,年龄70～94岁,平均年龄7815,在气管插管期间先后培养出99株绿脓杆菌,并做了药物敏感。40例气管切开老年患者,有39例因C OPD伴发肺部感染,多次发生