目的探讨L型细菌在下呼吸道感染的作用 ,提高临床诊治水平。方法对 2 0 0例确诊为下呼吸道感染的患者采集经纤维支气管镜防污染支气管 肺泡灌洗液进行常规细菌、真菌和L型细菌培养 +药敏检测 ,对L型细菌培养阳性者采用敏感药物进行治疗。结果 2 0 0例患者共检出病原菌 2 18株 ,其中细菌型 130株 ,L型细菌 88株 ;单纯细菌型阳性 70例 ,同种细菌伴L型细菌 33例 ,异种细菌伴L型细菌 12例 ,单纯L型细菌阳性 36例 ;L型细菌主要有铜绿假单孢菌 18株 ,L型真菌 17株 ,金黄色葡萄球菌 11株 ,克雷白菌 7株 ,表皮葡萄球菌 6株。对L型革兰阴性杆菌敏感的药物依次为亚胺培南 西拉司丁钠、丁胺卡那霉素、环丙沙星、头孢他啶 ;对L型革兰阳性球菌敏感的药物依次为万古霉素、氯洁霉素、利福平、氯霉素。敏感药物对L型细菌感染治疗效果好。结论对下呼吸道感染患者 (特别是高发人群 )开展L型细菌的检测能够明显提高病原学的诊断水平 ,减少漏诊 ;同时指导临床合理使用抗生素 ,提高治疗效果。 Objective To investigate the role of L-type bacteria in lower respiratory tract infection and to improve the level of clinical diagnosis and treatment. Methods 200 cases of patients diagnosed as lower respiratory tract infection were collected by bronchoscopy bronchial pneumoconiosis lavage fluid routine bacterial, fungal and L-type bacterial culture + drug sensitivity test, positive for L-type bacterial culture using sensitive drugs For treatment. Results A total of 2 18 strains of pathogens were detected, of which 130 strains were bacterial and 88 strains were L-type bacteria. The number of bacteria was 70, the same bacteria were L-type bacteria, and the other bacteria were L-type bacteria. Cases, simple L-positive bacteria in 36 cases; L-type bacteria are Pseudomonas aeruginosa 18 strains, L-type fungi 17 strains, Staphylococcus aureus 11 strains, Klebsiella, Staphylococcus epidermidis 6 strains. The drugs sensitive to L gram-negative bacilli were imipenem, cilastatin sodium, amikacin, ciprofloxacin and ceftazidime; the drugs sensitive to L gram-positive cocci were vancomycin , Clindamycin, rifampicin, chloramphenicol. Sensitive drugs for L type bacterial infection treatment effect. Conclusion The detection of L-type bacteria in patients with lower respiratory tract infection (especially in high-risk population) can significantly improve the diagnosis of etiology and reduce the missed diagnosis. At the same time, it can guide clinical rational use of antibiotics and improve the therapeutic effect.