【摘要】：背景： 慢性阻塞性肺疾病(COPD)是一種以氣道、肺實(shí)質(zhì)和肺血管慢性炎癥導(dǎo)致氣流受限不完全可逆為特征的呼吸系統(tǒng)的常見病。由于C0PD患病人數(shù)多，死亡率高，社會(huì)經(jīng)濟(jì)負(fù)擔(dān)沉重，已成為一個(gè)重要的公共衛(wèi)生問題。就世界平均水平而言，居當(dāng)前死亡原因的第4位。根據(jù)世界銀行／世界衛(wèi)生組織發(fā)表的研究結(jié)果，至2020年COPD將躍升至世界疾病經(jīng)濟(jì)負(fù)擔(dān)的第5位。呼吸道感染是COPD加重、惡化的重要因素，預(yù)防呼吸道感染，減少COPD急性發(fā)作對(duì)于節(jié)約社會(huì)成本，降低醫(yī)療負(fù)擔(dān)，提高COPD患者生存質(zhì)量有重大意義。 目的： 通過對(duì)慢性阻塞性肺疾病(COPD)患者急性加重期及穩(wěn)定期病原菌分布情況進(jìn)行分析，為進(jìn)一步制定有針對(duì)性的干預(yù)對(duì)策提供理論依據(jù)。 方法： 分析我院2010年7月至2012年6月呼吸科收治的1107例慢性阻塞性肺疾病急性加重期(AECOPD)患者痰液細(xì)菌培養(yǎng)結(jié)果，對(duì)307例痰培養(yǎng)結(jié)果陽性患者于穩(wěn)定期行痰液細(xì)菌培養(yǎng)，以痰中病原菌濃度≥107CFU/ml作為診斷C0PD病原菌感染的標(biāo)準(zhǔn)。對(duì)穩(wěn)定期及急性加重期痰培養(yǎng)結(jié)果進(jìn)行分析，，并結(jié)合有統(tǒng)計(jì)學(xué)意義的一般臨床特征制定COPD患者急性加重期及穩(wěn)定期的干預(yù)對(duì)策。 結(jié)果： 患者的一般臨床特征：年齡、WBC、FEVl／FVC、PaO2、PaCO2、CRP、TNF-α、IL-18、IL-13急性加重期明顯高于穩(wěn)定期（P0.05）。急性加重期合格痰標(biāo)本389份，痰標(biāo)本合格率35.1%，檢出141株菌≥107CFU/ml，G-桿菌占67.4％(95株)，其中以銅綠假單胞菌、鮑曼不動(dòng)桿菌、嗜血桿菌多見；G+球菌占18.4％(26株)，以肺炎鏈球菌、金黃色葡萄球菌、溶血葡萄球菌為主；真菌占14.2％(20株)，曲霉菌11株，念珠菌9株；痰細(xì)菌培養(yǎng)陽性率為36.2％；穩(wěn)定期合格痰標(biāo)本307份，痰標(biāo)本合格率78.9%，檢出35株菌≥107CFU/ml，G-桿菌占74.2％(26株)，其中銅綠假單胞菌分離率最高，占40.0％(14株)，真菌占20.0％(7株)，G+球菌占5.8％(7株)；痰細(xì)菌培養(yǎng)陽性率為11.4％。急性加重期與穩(wěn)定期痰培養(yǎng)陽性結(jié)果相同31株（31例患者），其中13例支氣管擴(kuò)張，11例合并有2型糖尿病、高血壓病、冠心病，4例合并骨折，3例無基礎(chǔ)疾病。 結(jié)論： AECOPD住院患者痰標(biāo)本合格率低；病原菌以革蘭陰性桿菌為主；急性加重期痰培養(yǎng)陽性率低，非細(xì)菌感染因素導(dǎo)致的COPD病情加重不容忽視；穩(wěn)定期由于人為干預(yù)痰標(biāo)本合格率明顯升高，但痰培養(yǎng)結(jié)果陽性率更低，且多為合并有支氣管擴(kuò)張、2型糖尿病等基礎(chǔ)性疾病，細(xì)菌定植在普通COPD患者急性發(fā)作中的作用值得思考。在COPD患者不同時(shí)期給予相應(yīng)干預(yù)措施提高痰標(biāo)本合格率、增強(qiáng)患者自身免疫力，有助于減少經(jīng)驗(yàn)性用藥、縮短住院時(shí)間、避免醫(yī)療資源浪費(fèi)及住院費(fèi)用過多。
[Abstract]:Background: chronic obstructive pulmonary disease (COPD) is a common respiratory disease characterized by chronic inflammation of airway, lung parenchyma and pulmonary vessels, which leads to incomplete reversible airflow restriction. Because of the high number of C0PD, high mortality and heavy social and economic burden, it has become an important public health problem. In terms of the world average, it ranks fourth among the current causes of death. According to a study published by the World Bank / World Health Organization, COPD will jump to fifth place in the world's disease economic burden by 2020. Respiratory tract infection is an important factor for the aggravation and deterioration of COPD. It is of great significance to prevent respiratory tract infection and reduce the acute attack of COPD in order to save social cost, reduce medical burden and improve the quality of life of COPD patients. Objective: to analyze the distribution of pathogenic bacteria in patients with chronic obstructive pulmonary disease (COPD) during acute aggravation and stable stage, and to provide theoretical basis for further formulation of targeted intervention strategies. Methods: from July 2010 to June 2012, 1107 patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) were treated with sputum bacterial culture. Sputum bacterial culture was performed in 1107 patients with positive sputum culture results. The sputum pathogen concentration 鈮

本文編號(hào)：2503295