CT导引下支气管镜获取痰培养标本与常规吸痰管方法比较对重症肺炎患者的临床价值  

SPUTUM COLLECTION USING CT-GUIDED BRONCHOSCOPY COMPARED TO USUAL SUCTION CATHETER FOR SEVERE PNEUMONIA PATIENTS:A RANDOMISED CLINICAL TRIAL

作　　者：张军伟[1] 白静[1] 王建军[1] 李志强[1] 邱方[1] 

机构地区：[1]河北联合大学附属医院ICU,河北省唐山市063000

出　　处：《中国煤炭工业医学杂志》2014年第8期1269-1272,共4页Chinese Journal of Coal Industry Medicine

基　　金：唐山市科技局支撑项目(编号:12140209A-36)

摘　　要：目的评价与常规吸痰管方法相比,CT导引下支气管镜获取痰标本进行细菌培养对重症肺炎患者的临床有效性和安全性。方法选取该院ICU确诊重症肺炎的成年患者87例作为研究对象,随机分为常规吸痰管留取标本组(A组)45例和CT导引下支气管镜留取痰标本组(B组)42例。记录患者年龄,性别,开始试验时、治疗后48h、5d、7d的APACHEⅡ评分、肺感染评分、白细胞计数,机械通气时间,ICU住院时间,28d病死率,抗生素相关治疗费用和总治疗费用。结果二组性别、年龄差异无统计学意义(P>0.05)。开始治疗时、治疗后48h,二组APACHEⅡ评分和肺感染评分差异无统计学意义(P>0.05),但治疗后5d和7d时B组APACHEⅡ评分和肺感染评分明显低于A组(P<0.05)。开始治疗时,二组白细胞计数差异无统计学意义,但治疗后48h、5d和7d时,B组白细胞计数明显低于A组(P<0.05)。B组机械通气时间和ICU住院时间明显短于A组,抗生素相关治疗费用和总治疗费用比较明显低于A组(P<0.05)。二组患者28d病死率比较差异无统计学意义。CT导引下支气管镜获取痰标本操作无任何并发症的发生。结论 CT导引下支气管镜获取痰标本方法对重症肺炎患者安全有效,值得临床推广。Objective To compare the efficiency and safety of sputum collection using CT- guided broncho- seopy and usual suction catheter for severe pneumonia patients. Methods Eightyseven severe pneumonia patients selected from the ICU were randomly divided into two groups： 42 cases were in CT- guided bronchoscopy group, and 45 cases in usual suction catheter group. The following data were collected： age, gender, APACHE II score, Clinical Pulmonary Infection Score （CPIS） , white blood cells counting, the duration of mechanical ventilation, the duration in ICU, mortality at 28th day, cost related to treatment with antibiotics and the total cost during treatment in hospital. Results There was no statistical difference be- tween CT- guided bronchoscopy group and usual suction catheter group in APACHE II score and CPIS at Oh and 48h, but those of CT-guided bronchoscopy group were less significantly than usual suction cathe- ter group at 5d and 7d （P〈0.05）. The white blood cells counting didn＇t reach significant difference between 2 groups at Oh, but there was obviously significant at 48h, 5d and 7d in CT- guided bronchoscopy group（P〈0. 05）. The duration of mechanical ventilation, the duration in ICU, the cost related to treat- ment with antibiotics and the total cost during treatment in hospital were legs in CT- guided bronchoscopy group than usual suction catheter group （P^0.05）. The mortality was no difference in 28th day between 2 groups （P^0.05）. No adverse event was observed in CT- guided hronchoscopy group. Conclusions It is efficient and safe for sputum collection using CT- guided bronchoscopy compared to usual suction catheter for severe pneumonia patients.

关 键 词：支气管镜检查 痰 培养 X线计算机体层扫描 肺炎 随机对照试验 

分 类 号：R563.1[医药卫生—呼吸系统]