阻塞性睡眠呼吸暂停低通气综合症患儿扁桃体、腺样体细菌学研究

发布时间：2018-05-03 18:51

本文选题：阻塞性睡眠呼吸暂停低通气综合症 + 扁桃体　；参考：《上海交通大学》2014年硕士论文

【摘要】：目的分析阻塞性睡眠呼吸暂停低通气综合症（OSAHS）患儿扁桃体、腺样体表面和实体组织内的细菌种类、分布以及药物敏感情况，从而指导临床治疗，同时探讨细菌培养结果与渗出性中耳炎、变应性鼻炎、扁桃体、腺样体肥大程度之间的关系。方法随机选取2012年7月至2013年2月在上海交通大学附属儿童医院确诊的OSAHS并行手术的患儿213例，其中男140例，女73例，年龄1-13岁，平均年龄4.96±2.29岁。每例患儿分别送检鼻咽拭子、咽拭子、扁桃体实体组织、腺样体实体组织，①比较四组细菌培养结果有无差异性；②根据有无合并变应性鼻炎分为变应性鼻炎组（AR组）60例和非变应性鼻炎组（NAR组）91例，比较AR组与NAR组致病菌检出有无差异性；③根据有无合并渗出性中耳炎分为渗出性中耳炎组（OME组）22例和非渗出性中耳炎组（NOME组）80例，，比较OME组和NOME组致病菌检出有无差异性；④根据扁桃体肥大程度不同，比较Ⅱ度肥大组168例与Ⅲ度肥大组45致病菌检出有无差异性；⑤根据腺样体肥大程度不同，比较Ⅲ度肥大组44例和Ⅳ度肥大组78例致病菌检出有无差异性。结果 1.腺样体表面与实质细菌培养结果无统计学差异（2=0.162～1.554，P0.05）。 2.扁桃体表面与实质细菌培养结果无统计学差异（2=0.101～4.512，P0.05）。 3.OSAHS伴有OME组致病菌检出率低于NOME组（2=4.8014，P=0.02840.05）。进一步分析到菌种发现，金黄色葡萄球菌检出率OME组低于NOME组（2=0.0025，P=0.00540.05）；其它6种致病菌在两组之间检出率无统计学差异（2=0.0924～0.7609，P=0.2034～1.00000.05）。 4.OSAHS伴有AR组与NAR组致病菌检出率无统计学差异（2=0.1347～1.1828，P=0.2768～0.71360.05）。 5.OSAHS伴有扁桃体Ⅲ度肥大组致病菌检出率高于Ⅱ度肥大组（2=5.3036，P=0.02130.05）。进一步分析到菌种发现，金黄色葡萄球菌检出率Ⅲ°组高于Ⅱ°组（2=9.3431，P=0.00220.05）；其它6种致病菌在两组之间检出率无统计学差异（2=0.2205～0.3975，P=0.2852～1.00000.05）。 6. OSAHS伴有腺样体Ⅲ度肥大组与Ⅳ度组致病菌检出率无统计学差异（2=0.0000～1.5127，P=0.2187～0.1.00000.05）。 7.①金黄色葡萄球菌：对万古霉素100%敏感，对头孢类抗生素（如头孢唑啉、头孢呋辛）、β-内酰胺酶抑制剂复合物（氨苄西林/舒巴坦）敏感率较高（80%以上），对克林霉素，氨苄西林、红霉素敏感率依次降低，对青霉素耐药率达90%以上。MRSA对青霉素、头孢类抗生素、β-内酰胺抑制剂复合物100%耐药，但是磺胺类抗菌药复方新诺明100%敏感。②肺炎链球菌：对苯唑青霉素、红霉素、克林霉素耐药率达95%以上，对喹诺酮类（如莫西沙星）、万古霉素敏感率达100%。③化脓性链球菌：对单纯青霉素、万古霉素、头孢曲松100%敏感，对克林霉素、红霉素耐药率达94%。④流感嗜血杆菌、副流感嗜血杆菌：对阿莫西林/棒酸，阿奇霉素敏感率达90%以上，对头孢呋辛敏感率达80%以上，对喹诺酮类、氨苄西林/舒巴坦、氨苄西林敏感率依次降低，对克林霉素耐药率达80%以上。β-内酰酶阳性的HIN,HHE对头孢呋辛耐药率为100%，对氨苄西林/舒巴坦耐药率达90%以上。⑤肺炎克雷伯氏菌、铜绿假单胞菌：对所选抗生素如头孢类、β-内酰胺抑制剂复合物、亚胺培南敏感率几乎全达100%。结论 1.咽拭子细菌培养及药敏试验结果可以代表扁桃体实体组织细菌种类、分布及药物敏感程度。 2.鼻咽拭子细菌培养及药敏试验结果可以代表腺样体实体组织细菌种类、分布及药物敏感程度。 3.伴有渗出性中耳炎的OSAHS患儿，致病菌检出率低于非渗出性中耳炎的OSAHS患儿，我们认为可能是OME患儿在术前使用抗生素类药物干预的结果，也可能与中耳炎患者由于炎症反应而产生局部免疫而使细菌检出率降低有关。 4.伴有变应性鼻炎的OSAHS患儿与伴有NAR的OSAHS患儿致病菌检出率比较无统计学差异，需要更大样本的进一步深入研究。 5.伴有扁桃体Ⅲ度肥大组的OSAHS患儿，致病菌检出率高于Ⅱ度组，且主要是金黄色葡萄球菌检出率具有差异性，金葡菌感染与扁桃体肥大关系密切。 6.伴有腺样体Ⅲ度肥大的OSAHS患儿致病菌检出率与Ⅳ肥大的OSAHS患儿比较无统计学差异，目前还无法解释这一结果，需要更大样本的进一步深入研究。 7.合理规范的使用抗生素是以细菌培养及药物敏感性试验为基础的，因此，根据致病菌的特点和药物敏感试验结果有针对性地选择抗生素，且应用足够的剂量和疗程，可以提高治疗效果且减慢耐药菌株的产生。
[Abstract]:Objective to analyze the species, distribution and drug sensitivity of the tonsil, adenoid and solid tissue in children with obstructive sleep apnea hypopnea syndrome (OSAHS), to guide the clinical treatment, and to explore the relationship between the results of bacterial culture and oozing otitis media, allergic rhinitis, tonsillar and adenoid hypertrophy.
Methods from July 2012 to February 2013, 213 cases of OSAHS parallel surgery in the Affiliated Children's Hospital of Shanghai Jiao Tong University were randomly selected, of which 140 were male, 73 women, 1-13 years old, and the average age was 4.96 + 2.29 years old. Each case was examined for nasopharyngeal swabs, swabs, almond body tissues and adenoid body tissues, and the four groups were compared. There were no differences in the results of bacterial culture; (2) there were 60 cases of allergic rhinitis (group AR) and 91 cases of non allergic rhinitis (group NAR) based on or without allergic rhinitis, and there were no differences in the detection of pathogenic bacteria in group AR and group NAR; (3) 22 cases of otitis media group (group OME) and non exudative otitis media were divided into 22 cases and non exudative otitis media according to the otitis media with or without exudative otitis media. Group NOME (group NOME) had no difference in detection of pathogenic bacteria in group OME and NOME. (4) according to the degree of tonsillar hypertrophy, there was no difference between 168 cases of the hypertrophy group and 45 pathogenic bacteria in the group of III degree hypertrophy. 5. According to the degree of adenoid hypertrophy, 44 cases in the group of third degree hypertrophy and 78 cases of IV degree hypertrophy group were detected to be detected by pathogenic bacteria. Difference.
Result
1. there was no significant difference between the surface of adenoids and the results of parenchymal bacterial culture (2=0.162 ~ 1.554, P0.05).
2. there was no significant difference in tonsil surface and parenchymal bacterial culture (2=0.101 to 4.512, P0.05).
The detection rate of pathogenic bacteria in group 3.OSAHS with OME was lower than that of group NOME (2=4.8014, P=0.02840.05). Further analysis showed that the detection rate of Staphylococcus aureus in OME group was lower than that of group NOME (2=0.0025, P=0.00540.05), and there was no statistical difference between the other 6 pathogenic bacteria in the two groups (2=0.0924 ~ 0.7609, P=0.2034 to 1.00000.05).
4.OSAHS and AR group and NAR group had no significant difference in the detection rate of pathogens (2=0.1347 ~ 1.1828, P=0.2768 ~ 0.71360.05).
The detection rate of pathogenic bacteria in 5.OSAHS with tonsillar III degree hypertrophy group was higher than that of the hypertrophic group (2=5.3036, P=0.02130.05). Further analysis showed that the detection rate of Staphylococcus aureus was higher than that of group II (2=9.3431, P=0.00220.05), and there was no statistical difference between the other 6 pathogenic bacteria in the two groups (2=0.2205 ~ 0.3975, P=0.2852). ~ 1.00000.05).
There was no significant difference in the detection rate of pathogenic bacteria between 6. OSAHS and adenoid 3 degree hypertrophy group and grade IV group (2=0.0000 to 1.5127, P=0.2187 to 0.1.00000.05).
7. Staphylococcus aureus: sensitive to vancomycin 100%, the sensitivity of cephalosporins (cefazolin, cefuroxime), beta lactamase inhibitor complex (ampicillin / sulbactam) was higher (more than 80%), and the sensitivity rate of clindamycin, ampicillin and erythromycin decreased in turn, and penicillin resistance rate was over 90%.MRSA against Penicillium. Antibiotics, cephalosporins and beta lactam inhibitor complexes were 100% resistant, but sulfamethoxy compound Sulfamethoxine 100% was sensitive. (2) Streptococcus pneumoniae: the resistance to benzoxamillin, erythromycin and clindamycin was over 95%. Quinolones (such as moxifloxacin) and vancomycin were sensitive to 100%. suppurative Streptococcus: pure Penicillium. It was sensitive to 100% of vancomycin and ceftriaxone. To clindamycin, the resistance rate of erythromycin to erythromycin was 94%. (Haemophilus influenzae) and Haemophilus parainfluenza, the sensitivity of amoxicillin / stick acid to azithromycin was above 90%, and the sensitivity rate of cefuroxime was over 80%, and the sensitivity rate of quinolones, ampicillin / sulbactam and ampicillin decreased in turn. The resistance rate of clindamycin was above 80%. The resistance rate of HIN to beta lactamase positive, HHE to cefuroxime was 100%, and the resistance rate to ampicillin / sulbactam was over 90%. 5. Klebsiella pneumoniae, Pseudomonas aeruginosa: the sensitivity of imipenem to the selected antibiotics, such as cephalosporin, beta lactam inhibitor complex, and imipenem almost all up to 100%.
conclusion
1. the results of bacterial culture and drug sensitivity test of throat swab can represent the species, distribution and drug sensitivity of bacteria in tonsil tissue.
2. the results of bacterial culture and drug sensitivity test of nasopharyngeal swabs can represent the species, distribution and drug sensitivity of bacteria in the tissues of adenoids.
3. of OSAHS children with exudative otitis media, the detection rate of pathogenic bacteria is lower than that of OSAHS in non exudative otitis media. We think it may be the result of the use of antibiotics in children with OME before operation, and it may also be related to the reduction of bacterial detection rate with the inflammatory response of the otitis media.
4. there was no significant difference in the detection rate of OSAHS among children with allergic rhinitis and those with NAR in OSAHS. Further studies were needed for larger samples.
5. the incidence of pathogenic bacteria in OSAHS children with the tonsillar III degree hypertrophy group was higher than that of the second degree group, and the detection rate of Staphylococcus aureus was different. The infection of Staphylococcus aureus was closely related to the tonsil hypertrophy.
6. the detection rate of pathogenic bacteria in OSAHS children with adenoid hypertrophy is not statistically different from that of OSAHS children with hypertrophy. It is not possible to explain this result and need further in-depth study of a larger sample.
7. the rational use of antibiotics is based on bacterial culture and drug sensitivity tests. Therefore, the selection of antibiotics according to the characteristics of pathogenic bacteria and the results of drug sensitivity tests, and the application of sufficient doses and courses of treatment, can improve the effect of treatment and slow down the production of resistant strains.

【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R766

【参考文献】