比较3种采样方法在下呼吸道感染病原学诊断的价值  

Comparison of three sample collecting methods in the etiologic diagnosis of lower respiratory tract infection

作　　者：陈肖华[1] 凌宙贵[1] 唐贞明[1] 明莫瑜[1] 刘卫[1] 蒋连强[1] 

机构地区：[1]广西医科大学第四附属医院呼吸内科,广西柳州545005

出　　处：《临床肺科杂志》2017年第4期649-652,共4页Journal of Clinical Pulmonary Medicine

基　　金：广西区卫生厅自筹经费科研课题(NoZ2014380)

摘　　要：目的通过比较常规法留痰、改良式留痰及支气管肺泡灌洗(BAL)三种方法送检的标本合格率及病原菌检出率,探索它们在临床中的应用价值。方法收集下呼吸道感染住院病人送检的痰及支气管镜肺泡灌洗液标本,按采样途径的不同分为三组:对照组(A组):常规方法留痰,在入院后第二天早晨应用抗生素前,清水漱口后咳去第一口痰,然后用力咳出深部痰于无菌器皿中送检;改良留痰组(B组):采用西吡氯铵含片及含漱复方氯己定液后再留取痰标本;支气管肺泡灌洗液组(C组):经纤维支气管镜行支气管肺泡灌洗收集的标本培养。比较3种方法送检标本的合格率及病原菌检出率。结果 5年期间共有4,920份标本纳入本研究,其中A组3,338份、B组250份、C组1,332份。A组、B组及C组三种方法痰涂片的合格率分别为41.0%、70.4%和99.5%,B组及C组痰涂片的合格率均高于A组(P<0.001),B组痰涂片的合格率也低于C组(P<0.001);三组合格痰标本的病原菌检出率分别为30.1%、40.1%及87.2%,C组的病原菌检出率明显高于A组或B组(P<0.001),而且B组病原菌的检出率也高于A组(P=0.004)。结论常规咳痰标本的合格率及病原菌检出率较低,西吡氯铵含片含服和复方氯己定含漱液具有提高痰标本合格率和病原菌检出率的作用,而支气管肺泡灌洗较常规法留痰、改良式留痰法明显提高下呼吸道感染标本的合格率和病原菌检出率,临床可结合实际应用。Objective To compare the qualification rate and the pathogenic detection rate of samples with conventional expectorated sputum, modified expectorated sputum and bronchoalveolar lavage （BAL） so as to investi- gate their using values in clinic. Methods The inpatients with lower respiratory tract infection were divided into three groups according to the route of sample collecting. In the conventional expectorated sputum group （ the group A） , the patients expectorated sputum before using antibiotic as usually and then cultured in the asepsis ware. In the modified expectorated sputum group （the group B）, the patients expectorated sputum after taking Cetylpyridinium chloride buccal tablets （CPC） and the compound chlorhexidine gargle. In the BAL group （ the group C）, the sample was collected by BAL. The qualification rate and pathogenic detection rate of the 3 groups were compared. Results A total of 4,920 samples were included in the study, with 3,338 samples in the group A, 250 samples in the group B and 1,332 samples in the group C. The qualification rate of the 3 groups was 41.0%, 70. 4% and 99. 5% , respec- tively. The qualification rate of the group B or C was higher than the group A （P 〈0. 001 ）. At the same time, the qualification rate of the group C was higher than the group B （ P 〈 0. 001 ）. The pathogenic detection rates in the 3 groups were 30. 1% , 40. 1% and 87.2% , respectively. The pathogenic detection in the group C was higher than in the group A or B （P 〈0. 001 ）, and the pathogenic detection of the group B was higher than that of the group A （P = 0. 004）. Condusion The qualification rate and pathogenic detection rate of conventional expectorated sputum are very low, but modified expectorated sputum with cetylpyridinium chloride buccal tablets and compound chlorhexi- dine gargle can improve the qualification rate and the pathogenic detection rate of expectorated sputum. Compare to the Methods with conventional expectorated sputum and modified expectorated sput

关 键 词：咳痰标本 西吡氯铵含片 复方氯己定含漱液 支气管肺泡灌洗 

分 类 号：R446.5[医药卫生—诊断学] R56[医药卫生—临床医学]