保护性毛刷下呼吸道取样在肺部感染中的病原学诊断价值

发布时间：2018-02-25 08:07

本文关键词： 纤维支气管镜保护性毛刷保护性毛刷盲取技术细菌定量培养肺部感染　出处：《郑州大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：探讨纤维支气管镜保护性毛刷及保护性毛刷盲取技术结合细菌定量培养在重症肺部感染病原学诊断中的临床应用价值。方法：选取2010年10月至2012年1月收住郑州大学第一附属医院呼吸暨重症医学科重症监护病房(RICU)的重症肺部感染并行气管插管或气管切开机械通气的患者65例。先后同期应用纤维支气管镜保护性毛刷(FOB-PSB)、保护性毛刷盲取(BPSB)和一次性吸痰管采集下呼吸道分泌物进行细菌定量培养(QC),对三种方法分离的细菌种类,致病菌阳性率,污染率进行对比,并观察根据药敏试验结果应用抗生素后治疗的有效率。结果： (1)采集195份标本,每份标本统计出1株优势菌,共分离出病原菌163株,阳性率83.6%。将表皮葡萄球菌、产黑色素杆菌视为污染菌排除,则分离出致病菌阳性率70.8%。培养结果以革兰阴性杆菌占首位(119株,73%),其中以铜绿假单胞菌、肺炎克雷伯菌及鲍曼不动杆菌为主要病原菌：革兰阳性球菌占第2位,以金黄色葡萄球菌为主。 (2)不同采样方法细菌检出株数为纤维支气管镜保护性毛刷结合细菌定量培养(FOB-PSB-QC)58株(89.2%),保护性毛刷盲取术结合细菌定量培养(BPSB-QC)54株(83.1%),普通抽痰法51株(78.5%)。三者阳性率相比较无明显统计学意义(P均0.05)。将表皮葡萄球菌和产黑色素杆菌作为非致病菌予以剔除,致病菌的分离例数为FOB-PSB-QC57株(87.7%),BPSB-QC53株(81.5%),普通抽痰法28株(43.1%)。 (3)致病菌检出阳性率相互比较：FOB-PSB-QC与BPSB-QC比较差异不大,无明显统计学意义(P=0.33),FOB-PSB-QC与普通抽痰法及BPSB-QC与普通抽痰法比较差异较大,有统计学意义(P0.01)。培养出的163株阳性菌中污染菌25株(15.3%),FOB-PSB-QC1株(1.7%),BPSB-QC1株(1.8%),普通抽痰23株(45%),三种方法的防污染性能相比较：FOB-PSB-QC与BPSB-QC无明显统计学意义(P=0.7),FOB-PSB-QC与普通抽痰法及BPSB-QC与普通抽痰法比较,差异有统计学意义(P0.01)。对三组检测出的致病菌分布情况相比较差异均无统计学意义(P均0.05)。如果以FOB-PSB-QC为参照标准,BPSB-QC的敏感性82.8%,阳性预测值88.9%,两者分离出的细菌分布一致性为84.6%。常规痰细菌培养与之的一致性48.3%。结论： (1)经纤维支气管镜保护性毛刷取样结合细菌定量培养技术,能直达肺部感染灶,敏感性及特异性,防污染性能均明显优于常规检查方法,其安全性高,对于RICU中重症肺部感染患者可常规使用。 (2)保护性毛刷盲取技术与经纤维支气管镜保护性毛刷取样有相近的敏感性及特异性,且耗时短,费用低,对技术性要求稍低,可在临床推广使用。 (3)常规取痰技术与上述两种技术相比,虽然有弊端,但由于其风险更小费用更低,对技术要求更低,仍可继续应用,但操作过程中应注意无菌操作,尽量减少污染。
[Abstract]:Objective:. To explore the clinical value of fiberoptic bronchoscope protective brush and blind extraction of protective brush combined with bacterial quantitative culture in the etiological diagnosis of severe pulmonary infection. Methods:. From October 2010 to January 2012, 65 patients with severe pulmonary infection receiving tracheal intubation or tracheotomy mechanical ventilation in the Department of Respiratory and intensive Care Unit (ICU) of the first affiliated Hospital of Zhengzhou University were selected. The protective brush FOB-PSBP with fiberoptic bronchoscope, the BPSBs with the protective brush and the lower respiratory tract secretions were collected with a disposable sputum suction tube for quantitative culture. The bacteria were isolated by three methods. The positive rate and contamination rate of pathogenic bacteria were compared, and the effective rate of antibiotic treatment was observed according to the results of drug sensitivity test. Results:. 1) A total of 195 specimens were collected. One dominant strain was found in each specimen, 163 of which were isolated, and the positive rate was 83.6. Staphylococcus epidermidis and melanin producing bacillus were excluded as polluting bacteria. The positive rate of pathogenic bacteria was 70.8%. The results showed that gram-negative bacilli were the first strain of 73 strains. Among them, Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii were the main pathogens: Gram-positive coccus was the second. Staphylococcus aureus is the main. (2) the number of bacteria detected by different sampling methods was as follows: fiberoptic bronchoscope protective brush combined with bacterial quantitative culture (FOB-PSB-QC) 58 strains, protective brush blind extraction combined with bacterial quantitative culture (BPSB-QCU 54 strain), common sputum extraction method (51 strains) 78.55.The positive rates of the three were compared. Staphylococcus epidermidis and melanin producing bacillus were excluded as non-pathogenic bacteria. The isolated cases of pathogenic bacteria were FOB-PSB-QC57 strain 87.7 and BPSB-QC53 strain BPSB-QC53, which were 81.5 and 43.1, respectively. (3) the positive rate of detecting pathogenic bacteria was not significantly different from that of BPSB-QC. There was no significant difference between FOB-PSB-QC and ordinary sputum extraction method, and there was a great difference between BPSB-QC and common sputum extraction method, and there was no significant difference between FOB-PSB-QC and common sputum extraction method. 25 strains of contaminated bacteria were isolated from 163 strains of positive bacteria, 25 strains were found to be infected by FB-PSB-QC1 strain, and 1.78 strains of BPSB-QC1 strain were isolated from normal sputum, and 23 strains from common sputum extraction were compared with the normal sputum extraction method. There was no significant difference between the three methods in the prevention of pollution compared with BPSB-QC and FOB-PSB-QC method, and BPSB-QC compared with the ordinary sputum extraction method. There was no significant difference in the distribution of pathogenic bacteria between the three groups. If the sensitivity of BPSB-QC was 82.8 and the positive predictive value was 88.9, the distribution of bacteria isolated from the two groups was as follows: (1) the sensitivity of BPSB-QC was 82.8%, and the positive predictive value was 88. 9%. The sensitivity of sputum was 84.6. The consistency of bacterial culture with routine sputum was 48.3%. Conclusion:. 1) sampling of protective brush with fiberoptic bronchoscope combined with bacterial quantitative culture technique can direct to pulmonary infection foci, its sensitivity, specificity and anti-pollution performance are obviously superior to those of conventional methods, and its safety is high. It can be used routinely in patients with severe pulmonary infection in RICU. (2) Blind extraction of protective brushes has similar sensitivity and specificity to that of fiberoptic bronchoscopic brushes, short time consuming, low cost, low technical requirements, and can be popularized in clinical practice. 3) the conventional sputum extraction technique has disadvantages compared with the above two techniques, but because of its lower risk, lower cost and lower technical requirement, it can still be applied continuously, but it should pay attention to the aseptic operation and minimize the pollution during the operation.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.1

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