关键词：医院感染；肺炎，吸入；革兰阴性菌
【摘要】 目的 研究医院内肺炎(NP)发病机制和病原体来源。方法 动态对比胃腔、口咽部、下呼吸道菌群构成、定植次序，调查影响定植的因素。结果 52例患者采集到237份胃液、咽拭子标本。胃腔分离革兰阴性杆菌(GNB)菌株数多于口咽部(77株:51株)。其中胃腔肠杆菌科细菌明显多于口咽部(46株:24株)、且定植早1～2天。10例患者发生NP，3例观察到GNB从胃腔→口咽部→呼吸道的定植次序并致肺炎。结论 胃腔GNB可能是引起NP的重要来源，尤其是肠杆菌科细菌肺炎。
Gastric colonization and its effect on pathogenesis of nosocomial pneumonia MAJian , HU Bijie, HE Lixian. * Department of Medicine, HudongHospital, Shanghai 200129
【Abstract】 Objective To study the gastric colonization andits effect on development of nosocomial pneumonia(NP). Methods Weinvestigated the microorganism ( mainly pathogens) constitution, isolating sequences andrisk factors in gastric, oropharyngeal and lower respiratory tract flora. Microbiologiccultures of serially taken samples of gastric aspirates, oropharyngeal swabs andbronchoalveolar lavages (BALs) or sputums were performed at the time of ICU admission andsubsequently every morning in 52 surgical patients with nasogastric tube. Etiologicdiagnosis of NP was based on quantitative culture of BAL or sputum. Sequences ofcolonization were examined by comparing isolates of the same species with concordance ofminimum inhibitory concentration values to 12 antibiotics. Results Atotal of 237 pairs of gastric and oropharyngeal specimens were taken. 77 strains of gram-negative bacilli (GNB) isolated from stomach, more than the number of GNB isolated fromoropharynx (51 strains) ,P=0.007. Comparing the species, Enterobacteriaceae isolated fromstomach was much more than that from oropharynx (46 vs 24 strains, P=0.004), and in mostinstances stomach colonization was before oropharynx colonization one to two days.Isolating rates of Pseudomonas were the same in both kinds of specimens. On contrast,Acinetobacter colonization in oropharynx was much more than that in stomach (10 vs 3strains, P=0.049).Risk factors for GNB colonization in stomach included increased gastricpH, medications inhibiting gastric acid secretion (such as cimitidine, omeprazole), andsystemic use of cephalosporins. 10 patients developed NP and 5 GNB ( Enterobacter cloacae2, Pseudomonas aeruginosa 2, Acinetobacter anitratum 1) isolated from BAL or sputum in 4of 10 patients. A sequence of colonization from the stomach to the respiratory tractleading to pneumonia was observed in 3 patients. Conclusions It wassuggested that the stomach is likely to be an important source of pathogens leading to NP,especially Enterobacteriaceae pneumonia.
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