鼻内镜术后病情迁延的细菌学分析

目的:探讨慢性鼻-鼻窦炎(CRS)鼻内镜术后迁延不愈者鼻腔分泌物的细菌学特征。方法:选取单纯鼻中隔偏曲患者20例(对照组),取其中鼻道分泌物;选取首次接受鼻内镜手术的CRS患者30例(手术组),术中取中鼻道分泌物;取FESS术后随访3个月以上未达治愈标准的患者20例(迁延组),在鼻内镜下取中鼻道分泌物,分别做细菌培养和药物敏感试验,3组结果进行比较分析。结果:对照组检出细菌13株,手术组检出15株,迁延组检出15株,其检出阳性率差异无统计学意义;迁延组G-菌检出率明显高于对照组和手术组;对常用抗生素耐药的菌株比例迁延组显著高于手术组。结论:需氧菌可存在于正常鼻腔内;CRS术后迁延不愈者,G-杆菌的感染和细菌的耐药性明显增加。因此,强调要合理应用抗生素,对术后迁延性鼻窦炎的抗生素治疗,应建立在细菌培养和药敏试验的基础上。

Bacteriological analysis of persistent rhinosinusitis after endoscopic sinus surgery

Objective:To investigate the bacterial characteristics of persistent rhinosinusitis after functional endoscopic sinus surgery(FESS).Method: Twenty patients with nasal septum deviation,30 patients with chronic rhinosinusitis(CRS) and 20 patients with persistent rhinosinusitis,were selected to take discharges from middle meatus during the operation.Bacteria culture and drug susceptibility of the discharges were compared betweent three groups.Result:There were 13,15 and 15 isolates detected in nasal septum deviation group,CRS group and persistent rhinosinusitis group.There was no significant difference among the three groups at the detection rate of Gram-positive bacteria.But there was significant difference between the persistent rhinosinusitis group and the other two groups at the detection rate of Gram-negative bacteria.The detection rate of antibiotic-resistant bacteria were significantly higher in persistent rhinosinusitis group than in CRS group.Conclusion: Aerobic bacteria can live in nasal cavity.Bacteria infection is one of the etiological factors of persistent rhinosinusitis after FESS.Gram-negative bacteria and antibiotic resistant bacteria are increased in patients with persistent rhinosinusitis.To treat the persistent rhinosinusitis after surgery,the antibiotics should be reasonably used according to the bacteria culture and the drug susceptibility.