纤维支气管镜在热射病患者呼吸道感染早期诊断中的应用
发布时间：2018-11-02 18:25
【摘要】：目的：研究纤维支气管镜检查对热射病(Heat Stroke HS)患者呼吸道感染早期诊断的价值,进一步提高对热射病患者呼吸道感染的早期诊断。方法：选择我院ICU自2012年5月至2014年7月收治的热射病患者16例,所有患者均已开放气道,11例行经口气管插管,5例经鼻气管插管。16例患者进入ICU后第一天开始,每天早晨8:00左右分别用两种方法采集痰标本,分别为常规吸痰法和纤支镜吸痰法。两种采集顺序根据统计学完全随机化设计原则进行编号。常规采集痰标本方法,用吸痰管经气管导管吸痰留取标本；纤支镜法采集痰标本,患者仰卧,使用多功能心电监护,连续监测患者心率、血压、呼吸频率及血氧饱和度,躁动患者适当镇静,进行纤维支气管镜检查,跨越声门后,在分泌物最多处吸取分泌物致无菌积痰器,将积痰器送检验科做细菌培养加药敏试验。结果：(1)、16例热射病患者在进入ICU后24小时内痰培养均未培养出细菌；48小时内不同程度检出细菌,常规法占6%,纤支镜法占120%，显著高于常规组。(2)、纤支镜组入ICU第五天、常规组入ICU第七检出多重耐药菌,7天内送检标本中共分离培养出多重耐药菌44株,阳性率为78.57%,其中常规法16株,阳性率36.36%；纤支镜法28株,阳性率63.64%,有显著差异(P0.05)。革兰氏阴性菌31株(70.46%)常规法11株(25%),纤支镜法20株(45.45%),有显著差异(P0.05)；鲍曼不动杆菌为15株(34.09%),常规法7株(15.9%),纤支镜法8株(18.18%),无统计学差异(P0.05)；铜绿假单胞13株(29.55%),常规法7株(15.91%),纤支镜法6株(13.64%)无统计学差异(P0.05)；大肠埃希菌4株(9.09%)；革兰氏阳性菌10株(22.73%),常规法3株(6.8%),纤支镜法7株(15.91%),有显著差异(P0.05),主要是金黄色葡萄球菌6株(13.64%)均为纤支镜组检出,其他为肺炎链球菌和表皮葡萄球菌。结论：(1)纤维支气管镜诊断热射病患者呼吸道感染方法简单、安全,准确率高；(2)纤支镜对病原菌和多重耐药菌检出率高于常规吸痰,但对病原菌的种类检出无明显区别。
[Abstract]:Objective: to study the value of fiberoptic bronchoscopy in the early diagnosis of respiratory tract infection in patients with heat emitting disease (Heat Stroke HS). Methods: from May 2012 to July 2014, 16 patients with heat emitting disease admitted to our hospital from May 2012 to July 2014 were selected. All patients had open airway, 11 patients had oral tube intubation, 5 patients had nasal endotracheal intubation, 16 patients had been admitted to ICU on the first day. Two methods were used to collect sputum samples about 8:00 each morning: routine sputum aspiration and fiberoptic sputum aspiration. The two collection sequences were numbered according to the principle of complete randomization design of statistics. The sputum specimen was collected by routine method, and the specimen was retained by suction tube through trachea catheter. Sputum samples were collected by fiberoptic bronchoscopy, the patients were supine, multifunctional ECG monitoring was used, the heart rate, blood pressure, respiratory frequency and blood oxygen saturation were continuously monitored, the restless patients were properly sedated, fiberoptic bronchoscopy was performed, and after crossing glottis, The aseptic sputum accumulator caused by the most secretions was collected and sent to the laboratory for bacterial culture and drug sensitivity test. Results: (1) bacteria were not cultured in sputum culture within 24 hours after entering ICU. Bacteria were detected in different degrees in 48 hours, 6 by routine method, 120 by fiberoptic bronchoscopy, significantly higher than those in routine group. (2) on the fifth day of ICU, multidrug resistant bacteria were detected in routine group and ICU 7, respectively. Within 7 days, 44 strains of multidrug resistant bacteria were isolated and cultured, and the positive rate was 78.57. Among them, 16 strains were detected by routine method, and the positive rate was 36.36%. The positive rate of fiberoptic bronchoscopy was 63.64 and there was significant difference (P0.05). There were 31 Gram-negative strains (70.46%), 11 strains (25%) by routine method and 20 strains (45.45%) by fiberoptic bronchoscopy (P0.05). There were 15 strains (34.09%) of Acinetobacter baumannii, 7 strains (15.9%) by routine method and 8 strains (18.18%) by fiberoptic bronchoscopy. There was no statistical difference (P0.05). There were 13 Pseudomonas aeruginosa strains (29.55%), 7 strains (15.91%) by routine method, 6 strains (13.64%) by fiberoptic bronchoscopy (P0.05), 4 strains (9.09%) by Escherichia coli. 10 strains (22.73%) of Gram-positive bacteria, 3 strains (6.8%) of routine methods and 7 strains (15.91%) of fiberoptic bronchoscopy were significantly different (P0.05). Six strains of Staphylococcus aureus (13.64%) were detected by fiberbronchoscopy, the others were Streptococcus pneumoniae and Staphylococcus epidermidis. Conclusion: (1) the method of diagnosing respiratory tract infection by fiberoptic bronchoscopy is simple, safe and accurate. (2) the detection rate of pathogenic bacteria and multidrug resistant bacteria by fiberbronchoscope was higher than that of routine sputum aspiration, but there was no significant difference in the detection of pathogenic bacteria.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R594.11;R56
本文编号：2306599
[Abstract]:Objective: to study the value of fiberoptic bronchoscopy in the early diagnosis of respiratory tract infection in patients with heat emitting disease (Heat Stroke HS). Methods: from May 2012 to July 2014, 16 patients with heat emitting disease admitted to our hospital from May 2012 to July 2014 were selected. All patients had open airway, 11 patients had oral tube intubation, 5 patients had nasal endotracheal intubation, 16 patients had been admitted to ICU on the first day. Two methods were used to collect sputum samples about 8:00 each morning: routine sputum aspiration and fiberoptic sputum aspiration. The two collection sequences were numbered according to the principle of complete randomization design of statistics. The sputum specimen was collected by routine method, and the specimen was retained by suction tube through trachea catheter. Sputum samples were collected by fiberoptic bronchoscopy, the patients were supine, multifunctional ECG monitoring was used, the heart rate, blood pressure, respiratory frequency and blood oxygen saturation were continuously monitored, the restless patients were properly sedated, fiberoptic bronchoscopy was performed, and after crossing glottis, The aseptic sputum accumulator caused by the most secretions was collected and sent to the laboratory for bacterial culture and drug sensitivity test. Results: (1) bacteria were not cultured in sputum culture within 24 hours after entering ICU. Bacteria were detected in different degrees in 48 hours, 6 by routine method, 120 by fiberoptic bronchoscopy, significantly higher than those in routine group. (2) on the fifth day of ICU, multidrug resistant bacteria were detected in routine group and ICU 7, respectively. Within 7 days, 44 strains of multidrug resistant bacteria were isolated and cultured, and the positive rate was 78.57. Among them, 16 strains were detected by routine method, and the positive rate was 36.36%. The positive rate of fiberoptic bronchoscopy was 63.64 and there was significant difference (P0.05). There were 31 Gram-negative strains (70.46%), 11 strains (25%) by routine method and 20 strains (45.45%) by fiberoptic bronchoscopy (P0.05). There were 15 strains (34.09%) of Acinetobacter baumannii, 7 strains (15.9%) by routine method and 8 strains (18.18%) by fiberoptic bronchoscopy. There was no statistical difference (P0.05). There were 13 Pseudomonas aeruginosa strains (29.55%), 7 strains (15.91%) by routine method, 6 strains (13.64%) by fiberoptic bronchoscopy (P0.05), 4 strains (9.09%) by Escherichia coli. 10 strains (22.73%) of Gram-positive bacteria, 3 strains (6.8%) of routine methods and 7 strains (15.91%) of fiberoptic bronchoscopy were significantly different (P0.05). Six strains of Staphylococcus aureus (13.64%) were detected by fiberbronchoscopy, the others were Streptococcus pneumoniae and Staphylococcus epidermidis. Conclusion: (1) the method of diagnosing respiratory tract infection by fiberoptic bronchoscopy is simple, safe and accurate. (2) the detection rate of pathogenic bacteria and multidrug resistant bacteria by fiberbronchoscope was higher than that of routine sputum aspiration, but there was no significant difference in the detection of pathogenic bacteria.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R594.11;R56
【参考文献】
相关期刊论文 前1条
1 宋青;;热射病,致命的中暑[J];军医进修学院学报;2008年06期
，本文编号：2306599
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