痰涂片对ICU呼吸机相关性肺炎耐药菌治疗的指导意义  

Significance of sputum smear in guidance of treatment of ICU patients with ventilator-associated pneumonia caused by drug resistant bacteria

作　　者：孙晓霞[1] 方巍[1] 赵蕾[1] 

机构地区：[1]青岛大学医学院附属医院重症医学科,山东青岛266011

出　　处：《中华医院感染学杂志》2013年第22期5627-5628,共2页Chinese Journal of Nosocomiology

摘　　要：目的了解痰涂片对ICU耐药革兰阳性球菌呼吸机相关肺炎(VAP)治疗的指导意义。方法收集ICU呼吸机相关性肺炎患者送检痰标本206份,均行痰涂片和痰培养检查,将痰涂片阳性92份随机分A、B两组,A组44份给予抗革兰阳性球菌治疗,B组48份待痰培养结果,阳性者给予抗革兰阳性球菌治疗;对治疗有效率、治愈率、病死率、平均住院天数、抗革兰阳性球菌治疗时间、机械通气时间、住院费用进行统计分析。结果 206份痰标本中痰涂片找到革兰阳性球菌92份,其中培养出耐药革兰阳性球菌86株、敏感革兰阳性球菌3株,阴性标本3份,符合率93.5%;痰涂片与痰培养差异有统计学意义(P<0.01);痰涂片A、B两组在临床治疗有效率、治愈率、病死率差异无统计学意义;A组平均住院天数(28.6±15.3)d、抗革兰阳性球菌治疗时间(28.6±15.3)d、机械通气(16.3±9.4)d、住院费用(123 200±23 200)元,明显低于B组(P<0.05)。结论痰涂片对ICU耐药革兰阳性球菌呼吸机相关性肺炎早期诊断和治疗有较大的临床指导价值。OBJECTIVE To explore the significance of sputum smear in guiding the treatment of ventilator-associated pneumonia （VAP） caused by drug resistant gram-positive cocci in ICU. METHODS Totally 206 sputum specimens were collected from the ICU patients with VAP, then the sputum smear and sputum culture were performed, and 92 positive sputum smear were randomly divided into the group A and the group B, 44 cases in the group A received the anti-gram-positive cocci therapy, while the cases with positive sputum culture in the group B （n=48） were given the anti-gram-positive cocci therapy; the effective rate of treatment, cure rate, mortality, average hospitalization duration, time of anti-gram-positive cocci therapy, duration of mechanical ventilation, and hospitalization cost were statistically analyzed. RESULTS A total of 92 strains of gram-positive cocci have been isolated from 206 sputum specimens through sputum smear, among which 86 strains of drug-resistant gram- positive cocci and 3 strains of drug-susceptible gram-positive cocci were identified, with three specimens cultured positive, the accordance rate was 93.5%, the difference between the sputum smear and the sputum culture was significant（P〈0. 01）;the difference in the effective rate of clinical treatment, the cure rate, or the mortality between the group A and the group B was not significant. The average hospitalization duration of the group A was （28.6±15.3） d, time of anti-gram-positive cocci therapy（28. 6±15.3） d, the duration of mechanical ventilation （16.3±9.4）d, and hospitalization cost 123 200±23 200） yuan, which were significantly shorter or less than those of the group B（P〈0.05）. CONCLUSION The sputum smear has great significance in the guidance of early diagnosis and treatment of VAP caused by drug resistant gram-positive cocci in ICU.

关 键 词：痰涂片 耐药革兰阳性球菌 呼吸机相关性肺炎 

分 类 号：R446[医药卫生—诊断学]