支气管黏膜活检联合保护性毛刷细菌定量培养对机械通气下呼吸道耐药菌感染的诊断价值  

Diagnostic Value of Bronchial Mucosa Biopsy and Quantitative Culture in Lower Airway Colonization and Infection in Patients with Invasive Mechanical Ventilation

作　　者：阎锡新[1] 祁春艳[1,2] 赵媛媛[1,3] 潘文森 张鲁涛[1] 时东彦[4] 

机构地区：[1]河北医科大学第二医院呼吸内科,河北石家庄050000 [2]石家庄市第一医院呼吸二科 [3]衡水市哈励逊医院重症医学科 [4]河北医科大学第二医院微生物实验室,河北石家庄050000

出　　处：《中国呼吸与危重监护杂志》2011年第3期233-236,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：河北省科技支持计划(编号:092761010-32)

摘　　要：目的探讨经支气管镜黏膜活检联合细菌定量培养对机械通气下呼吸道耐药菌定植与感染判定的可行性及诊断价值。方法选取河北医科大学第二医院呼吸重症加强治疗病房(RICU)行机械通气且药敏结果提示存在多耐药菌患者50例,依据综合分析原则,分为定植组和感染组。结合患者的一般情况、APACHEⅡ评分、CPIS评分等,比较其临床特征及意义;两组患者均行经支气管镜黏膜活检及细菌定量培养等,分析各方法单项及联合诊断的敏感性和特异性。结果感染组23例,定植组27例,两组患者在机械通气时间、ICU住院时间、尿管留置时间、疾病构成、耐药菌出现前抗生素使用情况等方面均存在显著差异(P<0.05)。动态CPIS评分显示感染组均高于定植组,但仅在插管14 d时有显著性差异(P<0.05)。支气管黏膜活检:感染组炎症反应检出率显著高于定植组(P<0.05)。感染组的炎细胞总数和中性粒细胞计数亦显著高于定植组(P<0.05);细菌定量培养:感染组阳性率明显高于定植组(P<0.05);组织病理与定量培养联合灵敏度和特异度最高,为呼吸及相关下呼吸道感染诊断准确性最佳方法。结论支气管黏膜活检联合细菌定量培养,在鉴别耐药定植菌或感染菌方面诊断价值较高,临床可行性有待进一步大规模证实。缩短机械通气时间、ICU住院时间及尿管留置时间等,有助于减少定植菌的发生。Objective To investigate the value of bronchial mucosa biopsy and quantitative culture in the differential diagnosis of lower airway bacterial colonization and infection.Methods A prospective observational cohort survey on MDR Pseudomonas aeruginosa and Acinetobacter baumannii was carried out in intubed or tracheotomized patients with invasive ventilation in respiratory intensive care unite(RICU).A total of 50 ICU patients were followed for the detection of MDR pathogen colonization or infection from June 2008 to October 2009.All subjects were divided into an infection group and a colonization group according to the outcome of patients discharged from the RICU.Baseline information,APACHEⅡ scores,and CPIS scores were recorded on individual forms for each patient untill discharge or death.Bronchial mucosa biopsy was conducted on appropriate time to identify whether the patient was comfirmed as infection.Microbiological diagnosis was performed with quantitative culture.Results Fifty patients were enrolled in this study,of which infected in 23 cases and colonized in 27 cases.The time of invasive mechanical ventilation,length of ICU stay,catheter indwelling time,and the kinds of disease were significantly different between the two groups(P<0.05).The kinds of using antibiotics before onset of multi-drug resistance of bacteria showed that cefoxitin/cefmetazole and mezlocillin also had significant difference between the infection group and the colonization group.The results of dynamic CPIS score of the infection group showed that scores at each timepoint were higher than those in the colonization group.However,the results of t-test showed that there was higher score in the infection group than that in the colonization group on 14 days after intubation(P<0.05).The bronchial mucosa biopsy showed that airway inflammation was detected in 19 cases in the infection group and 9 cases in colonization group.The positive rate in the infection and the colonization group were 55.6% and 25.0%,respectively assessed by traditional th

关 键 词：支气管黏膜活检 定量培养 多重耐药菌 定植 感染 

分 类 号：R56[医药卫生—呼吸系统]