BAL联合M-ROSE在潜在供肺维护中的作用  

The Effects of Bronchoalveolar Lavage Combined with Microbiological Rapid on-site Evaluation in the Maintenance of Potential Donor Lung

作　　者：龚丽明[1] 冉江华[2] 王胤佳[3] 李志伟[3] 杨倩[4] 王清[5] 王东坤[1] 唐正能 GONG Liming;RAN Jianghua;WANG Yinjia;LI Zhiwei;YANG Qian;WANG Qing;WANG Dongkun;TANG Zhengneng(Dept.of Cardiothoracic Surgery,The 1st People’s Hospital of Kunming,The Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650011,China;Dept.of Hepatobiliary Surgery,The 1st People’s Hospital of Kunming,The Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650011,China;Dept of Intensive Care Unit,The 1st People’s Hospital of Kunming,The Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650011,China;Dept.of Pathology,The 1st People’s Hospital of Kunming,The Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650011,China;Dept.of Respiratory and Critical Care Medicine,The 1st People’s Hospital of Kunming,The Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650011,China)

机构地区：[1]昆明医科大学附属甘美医院心胸外科,云南昆明650011 [2]昆明医科大学附属甘美医院肝胆外科,云南昆明650011 [3]昆明医科大学附属甘美医院重症监护室,云南昆明650011 [4]昆明医科大学附属甘美医院病理科,云南昆明650011 [5]昆明医科大学附属甘美医院呼吸与危重症医学科,云南昆明650011

出　　处：《昆明医科大学学报》2024年第1期107-115,共9页Journal of Kunming Medical University

基　　金：昆明市卫生科技人才培养项目暨“十百千”工程基金资助项目[2016-sw(省)-40];昆明市科技局科技保障民生发展重点基金资助项目(2019-1-S-25318000001168);昆明市卫生健康委员会卫生科研基金资助项目(2020-04-02-111)。

摘　　要：目的探讨BAL联合M-ROSE在潜在供肺维护中的作用。方法选取昆明医科大学附属甘美医院重症医学科2020年09月至2022年12月收治的符合纳入标准的脑死亡患者行BAL,留取灌洗液行M-ROSE比较病原菌检出率及初步诊断时间。根据M-ROSE结果阳性的患者采用经验性抗感染治疗,评估抗感染治疗48 h前后的氧合指数、胸部X线评分、感染指标(WBC、CRP、PCT)变化。结果(1)病原菌检出率比较:MROSE对细菌感染初步诊断结果与检验科报告的结果表现出高度一致性(Kappa=0.921,P<0.001);(2)诊断时效性比较:M-ROSE初步诊断时间与常规涂片报告时间、微生物培养时间比较,差异有统计学意义(P<0.001);(3)抗感染治疗48 h的疗效比较:抗感染治疗前后氧合指数,白细胞,超敏C反应蛋白差异无统计学意义(P>0.05);抗感染治疗前后胸部X线,降钙素原差异有统计学意义(P<0.05)。结论BAL联合M-ROSE在潜在供肺肺部感染中的诊断时效性高,可以为供肺维护早期抗感染治疗提供初步的依据。Objective To explore the effects of bronchoalveolar lavage combined with microbiological rapid on-site evaluation in potential donor lung maintenance.Methods Brain death patients who met the inclusion criteria and were admitted to the Intensive Care Unit(ICU)of Calmette Hospital Affiliated to Kunming Medical University from September 2020 to December 2022 were selected for bronchoalveolar lavage(BAL)and(BAL)and the lavage fluid were collected for M-ROSE to compare the pathogen detection rate and initial diagnosis time.According to the positive results of the microbiological rapid on-site evaluation,patients with the brain death were treated with empirical anti-infective therapy,and the oxygenation index,chest X-ray score,and the infection index(WBC,CRP,PCT)of anti-infective treatment 48 hours were evaluated.Results 1.Comparison of the detection rate of pathogenic microorganisms:The results of M-ROSE were highly consistent with a routine microbiological smear(Kappa=0.921,P<0.001).2.Comparison of diagnostic time:The initial diagnosis time of M-ROSE was significantly lower than routine microbiological smear time and microbial culture time(P<0.001).3.Comparison of therapeutic effects of anti-infective therapy for 48 hours:There was no significant difference in oxygenation index,white blood cells and hypersensitive C-reactive protein before and after the anti-infective treatment(P>0.05).There were significant differences in procalcitonin and chest X-ray before and after the anti-infective treatment(P<0.05).Conclusion Bronchoalveolar lavage combined with microbiological rapid on-site evaluation has the high timeliness in the diagnosis of potential donor pulmonary infection,which can provide a preliminary basis for the early anti-infective therapy of donor lung maintenance.

关 键 词：肺移植 脑死亡 供肺维护 肺泡灌洗 微生物快速现场评估 

分 类 号：R617[医药卫生—外科学]