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[厌氧性呼吸道感染的临床研究]

[Clinical study of anaerobic respiratory infection].

作者信息

Ohnishi Y, Sawaki M, Mikasa K, Konishi M, Hamada K, Takeuchi S, Maeda K, Kunimatsu M, Sano R, Masutani T

机构信息

Second Department of Internal Medicine, Nara Medical University.

出版信息

Kansenshogaku Zasshi. 1993 Apr;67(4):336-41. doi: 10.11150/kansenshogakuzasshi1970.67.336.

Abstract

This clinical study involved 35 cases, anaerobic bacteria were detected by TTA (transtracheal aspiration) or percutaneous lung aspiration, or pleural puncture. These cases were treated over the last 8 years in our department. There were 9 empyema, 9 pneumonitis, 5 lung abscess, 1 necrotizing pneumonia and 11 chronic lower airway infection. In 13 cases (37%), anaerobic bacteria alone were detected, whereas both anaerobic and aerobic bacteria were observed in the other 22 cases (63%). Of all bacteria detected. Bacteroids and Peptostreptococcus were the most common. With respect to host factors involved in the pathogenesis of pleural and parenchymal infection, aspiration was though to be a major trigger in only 11 out of the 24 cases (46%). The other 13 cases (54%) showed no evidence of aspiration, indicating that some other triggers was responsible. In further study, these 13 cases were found either to be heavy smokers with Brinkman index of more than 600, or to show sign of chronic lower airway infection. Both conditions were characterized by an inhibition of the mucociliary transport in the lower airway. Therefore, this study suggested that in the case without apparent aspiration the failure of local defense mechanisms in the airway, as a result of heavy smoking and/or chronic lower airway infection are involved in the pathogenesis of anaerobic respiratory infection.

摘要

这项临床研究涉及35例患者,通过经气管吸引(TTA)、经皮肺穿刺或胸腔穿刺检测厌氧菌。这些病例是过去8年在我们科室接受治疗的。其中有9例脓胸、9例肺炎、5例肺脓肿、1例坏死性肺炎和11例慢性下呼吸道感染。在13例(37%)中仅检测到厌氧菌,而在其他22例(63%)中同时观察到厌氧菌和好氧菌。在所有检测到的细菌中,拟杆菌属和消化链球菌最为常见。关于胸膜和实质感染发病机制中涉及的宿主因素,在24例病例中只有11例(46%)认为误吸是主要诱因。其他13例(54%)没有误吸证据,表明存在其他诱因。在进一步研究中,发现这13例患者要么是吸烟严重、Brinkman指数超过600的吸烟者,要么有慢性下呼吸道感染迹象。这两种情况的特征都是下呼吸道黏液纤毛运输受到抑制。因此,本研究表明,在无明显误吸的情况下,吸烟严重和/或慢性下呼吸道感染导致的气道局部防御机制失效参与了厌氧性呼吸道感染的发病过程。

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