成年人慢性鼻-鼻窦炎鼻内镜术后的细菌学研究

目的探讨成年人慢性鼻-鼻窦炎（chronicrhinosinusitis，CRS）患者鼻内镜手术（endoscopicsinussurgery，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B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（Gramnegativebacteria，GNB）占51．2％（330／645）；革兰阳性菌（Grampostivebacteria，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（mutipledrugresistance，MDR）菌株检出阳性率较术前明显增加。迁移不愈组B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（X2=4．85，P〈0．05）。痊愈组与对照组间B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。

Bacteriological study on adult chronic sinusitis operated after endoscopic sinus surgery

OBJECTIVE: To explore the bacteria isolated from middle nasal meatus, maxillary sinus, ethmoid sinus and postoperative cavity of patients with chronic rhinosinusitis and their characteristics of antibiotic resistance. METHODS: Eighty-seven patients with chronic rhinosinusitis were operated on by ESS to obtain the pus specimen for bacterial culture and antibiotic suseptibility test, before and 1 month, 3 months and 6 months after operation. RESULTS: Totally 645 strains (26 species) of bacteria were detected in 464 specimens [total positive rate was 78.9% (366/464)], in which aerobic bacteria was 95.3% (615/645). Gram negative bacteria and gram positive bacteria were 51.2% (330/645) and 48.8% (315/645), respectively. There was supernumerary tendency in detectable rate of gram negative bacteria isolated from postoperative groups. The main pathogens of postoperative patients were gram negative bacteria, with Enterobacter aerogenes, Pseudomonas aeruginosa and Hemophilus influenza occupying the first 3 places. The detectable rate of mutiple drug resistance bacteria in postoperative group was much higher than preoperative groups, in which gram negative bacteria was the most, especially for Pseudomonas aeruginosa. There was significant difference in beta-lactamase detectable rate of the bacteria isolated from the delayed recovery group and the preoperative group (chi2 = 4.85, P < 0.05), Enterobacteriaceae occupied the first place among the beta-lactamase detectable bacteria isolated from the delayed recovery group. There was no significant difference in detectable rate of kinds of bacteria isolated from recovery group and control group. CONCLUSIONS: The main pathogens of patients with chronic rhinosinusitis are mutiple drug resistance gram negative bacteria after operation, in which Pseudomonas aeruginosa occupies the first place. Gram negative bacteria are becoming the main opportunity pathogenic bacteria, which shows antibiotic resistance. microbial population of postoperative cavity from recovery group are becoming balanced.