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目的探讨成年人慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)患者鼻内镜手术(endoscopic sinus surgery,ESS)后的细菌分布和耐药性特征。方法实验组来自87例 CRS 患者 ESS术中中鼻道、上颌窦、筛窦和术后1、3、6个月复诊时的术腔分泌物;对照组为30例鼻中隔偏曲(无鼻炎、鼻窦炎)患者的中鼻道分泌物。所取标本分别作细菌培养、药物敏感实验及β内酰胺酶菌株检测。结果 464份标本共检出细菌645株26种,总细菌检出阳性率78.9%(366/464)。其中革兰阴性菌(Gram negative bacteria,GNB)占51.2%(330/645);革兰阳性菌(Gram postive bacteria,GPB)占48.8%(315/645);73.6%(64/87)的患者为混合菌生长。需氧菌为主占95.3%(615/645),厌氧菌仅占4.7%(30/645)。CRS 患者术后 GNB 检出阳性率较术前明显增加,以产气肠杆菌、铜绿假单胞菌和流感嗜血杆菌最为常见;术后1个月、3个月组厌氧菌检出阳性率为3.4%(3/87)和2.3%(2/87),较术前9.2%(8/87)明显降低,而迁移不愈组反而升高,占15.4%(2/13)。术后多重耐药(mutipledrug resistance,MDR)菌株检出阳性率较术前明显增加。迁移不愈组β内酰胺酶检出率为30.8%(4/13),其中以铜绿假单胞菌最为常见;而术前阳性检出率为19.5%(17/87),以金黄色葡萄球菌为主,两组间差异有统计学意义(x~2=4.85,P<0.05)。痊愈组与对照组间β内酰胺酶阳性率和菌种分布的差异无统计学意义。结论 GNB 是 CRS 患者术后不容忽视的重要条件致病菌或致非条件病菌,CRS 术后迁延不愈与 MDR-GNB 的优势生长有一定的关系。术后痊愈患者鼻腔和鼻窦的细菌微生态逐步恢复平衡。
Objective To investigate the bacterial distribution and drug resistance of adult patients with chronic rhinosinusitis (CRS) after endoscopic sinus surgery (ESS). Methods The experimental group consisted of 87 cases of CRS patients with ESS intraoperative nasal, maxillary sinus, ethmoid sinus and postoperative 1,3,6 months postoperative referral of secretions; control group was 30 cases of nasal septum deviation (no rhinitis, Sinusitis) in patients with the middle nasal secretions. The specimens were taken for bacterial culture, drug-sensitive experiments and beta lactamase strains detected. Results A total of 26 strains of 645 bacteria were detected in 464 samples. The positive rate of total bacteria was 78.9% (366/464). Gram negative bacteria (GNB) accounted for 51.2% (330/645); Gram-negative bacteria (GPB) accounted for 48.8% (315/645); 73.6% (64/87) For mixed bacteria growth. Aerobic bacteria accounted for 95.3% (615/645), anaerobic bacteria accounted for only 4.7% (30/645). The positive rate of GNB detected in patients with CRS was significantly higher than that before operation, with Enterobacter aerogenes, Pseudomonas aeruginosa and Haemophilus influenzae were the most common. Anaerobic bacteria were detected positive in 1 month and 3 months after operation Rates were 3.4% (3/87) and 2.3% (2/87), respectively, which were significantly lower than those of 9.2% (8/87) preoperatively, while the migrating unhealed patients increased but accounted for 15.4% (2/13). The positive rate of postoperative mutipledrug resistance (MDR) was significantly higher than that before operation. The detection rate of β-lactamase in the untreated group was 30.8% (4/13), of which Pseudomonas aeruginosa was the most common. The preoperative positive detection rate was 19.5% (17/87) Cocci, the difference between the two groups was statistically significant (x ~ 2 = 4.85, P <0.05). There was no significant difference between the recovery group and the control group in the positive rate of β-lactamase and the strain distribution. Conclusion GNB is an important pathogen or non-conditional pathogen that can not be ignored after operation in patients with CRS. The delayed healing after CRS has a certain relationship with the predominant growth of MDR-GNB. After the recovery of patients with nasal and sinus bacteria gradually restore the balance of microbial ecology.