支气管黏膜活检与毛刷细菌定量培养对机械通气患者下呼吸道耐药菌感染的诊断评价  

The value of bronchial mucosa biopsy and brush quantitative culture in the diagnosis of patients who received mechanical ventilation and occurred lower respiratory tract infections caused by drug resistant bacteria

作　　者：臧金萍[1] 冯静[2] 陈思[2] 

机构地区：[1]郑州人民医院呼吸内科,河南郑州450003 [2]郑州人民医院颐和医院呼吸科,河南郑州450047

出　　处：《中华医院感染学杂志》2015年第16期3653-3654,3657,共3页Chinese Journal of Nosocomiology

基　　金：河南省卫生厅肿瘤医药卫生基金资助项目(201203143)

摘　　要：目的研究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,为临床诊治提供理论依据。方法选取2012年4月-2013年4月医院60例使用机械通气疑似下呼吸道耐药菌感染患者,根据分析评定,分成为定植组34例和感染组26例,对60例患者进行支气管黏膜活检联合保护性毛刷细菌定量培养,检测下呼吸道耐药菌感染情况,对比记录联合检测方法与常规检测方法在诊断上的差异性,数据采用SPSS 19.0软件进行分析。结果患者APACHEⅡ评分定植组为(19±5)分、感染组为(22±4)分;定植组患者中发生呼吸衰竭最高占52.94%,发生重症肺炎最低占2.94%;感染组无神经肌肉疾病患者,但发生呼吸衰竭也最高,占53.85%;联合诊断比单一诊断方法在特异性和灵敏度均有显著优势,误诊率较低。结论使用支气管黏膜活检联合保护性毛刷细菌定量培养,对机械通气患者下呼吸道耐药菌感染的诊断价值高。OBJECTIVE To study the value of bronchial mucosa biopsy and brush quantitative culture in the diagno‐sis of patients who received mechanical ventilation and occurred lower respiratory tract infection caused by drug re‐sistant bacteria so as to provide references for clinical diagnosis .METHODS From Apr .2013 to Apr .2014 ,60 ca‐ses of patients with suspected lower respiratory tract infections after using mechanical ventilation were selected . They were divided into planting group with 34 cases and infection group with 26 cases .The 60 patients underwent bronchial mucosa biopsy jointed with protective brush quantitative bacterial cultures to detect drug‐resistant lower respiratory tract infections .The conventional method and the joint detection method were compared in the diagno‐sis and all data were analyzed statistically by SPSS 19 .0 software .RESULTS Patients in the planting group got （19 ＆#177; 5） points in the APACHE Ⅱ score and patients in infection group got （22 ＆#177; 4） points .In the planting group , respiratory failure ,which occurred most often ,reached 52 .94% ,and the severe pneumonia ,which seldom hap‐pened ,accounted for 2 .94% ;while in infection group ,no neuromuscular diseases were found in patients but the respiratory failure rate was the highest ,accounting for 53 .85% .Combined diagnosis method had significant ad‐vantage in specificity and sensitivity than the single diagnosis method with low misdiagnosis rate .CONCLUSION The use of bronchial mucosa biopsy combined with protective brush quantitative culture has high value in diagno‐sing patients with drug‐resistant bacteria infection caused by mechanical ventilation .

关 键 词：支气管黏膜活检 保护性毛刷 细菌定量培养 机械通气 耐药菌感染 

分 类 号：R378[医药卫生—病原生物学]