经支气管镜防污染毛刷取样辅助病原学诊断在儿童重症支原体肺炎中的应用价值分析  

Analysis of the application value of fiberoptic bronchoscopy-protected specimen brush assisted etiological diagnosis in children with severe mycoplasma pneumonia

作　　者：杨晓林 寇晓辉 曹焕珍[1] 李娟 陈欢欢 YANG Xiao-lin;KOU Xiao-hui;CAO Huan-zhen(Department of Pediatrics,Yellow River Sanmenxia Hospital,Sanmenxia Henan 472000,China)

机构地区：[1]黄河三门峡医院儿科,河南三门峡472000

出　　处：《临床和实验医学杂志》2024年第4期434-438,共5页Journal of Clinical and Experimental Medicine

基　　金：河南省医学科技攻关联合共建项目(编号:LHGJ20221041)。

摘　　要：目的 分析经支气管镜防污染毛刷取样(FOB-PSB)辅助病原学诊断在儿童重症支原体肺炎中的应用价值。方法 选取2022年5月至2023年8月黄河三门峡医院收治的100例重症支原体肺炎患儿进行回顾性研究,均采用FOB-PSB、经电子支气管镜下支气管肺泡灌洗取样法(PBAL)和常规留痰法取样,分析3种取样方法的阳性检出率和病原菌检出率;并对革兰阴性菌和革兰阳性菌行药敏试验,分析革兰阴性菌和革兰阳性菌的平均耐药率、平均敏感度;同时评估阳性患者经药敏试验调整抗菌药物后的临床治疗效果。结果 FOB-PSB取样法阳性检出率为93.00%,高于PBAL取样法、常规留痰法(79.00%、62.00%),PBAL取样法高于常规留痰法,差异均有统计学意义(P<0.05)。3种取样方法检测均以革兰阴性菌为主;FOB-PSB取样法革兰阴性菌检出率为88.17%,明显高于PBAL取样法、常规留痰法(73.42%、64.52%),差异均有统计学意义(P<0.05)。革兰阴性菌对氨苄西林、头孢唑林、头孢曲松、喹诺酮类耐药性较高,对亚胺培南、哌拉西林、阿卡米星、氨曲南、替加环素敏感度较高;革兰阳性菌对β-内酰胺类、青霉素耐药性较高,对利奈唑胺、利福平、万古霉素敏感度较高。革兰阴性菌和革兰阳性菌的平均耐药率、平均敏感度比较,FOB-PSB取样法均高于PBAL取样法、常规留痰法,PBAL取样法高于常规留痰法,差异均有统计学意义(P<0.05)。阳性患者经药敏试验调整抗菌药物后的总有效率比较,FOB-PSB取样法为96.77%,均高于PBAL取样法、常规留痰法(88.61%、75.81%),PBAL取样法高于常规留痰法,差异均有统计学意义(P<0.05)。结论 FOB-PSB辅助病原学诊断对儿童重症支原体肺炎阳性检出率较高,可有效明确患儿的感染致病菌及其药物耐药性,有利于进一步提升患儿的临床治疗效果。Objective To analyze the application value of fiberoptic bronchoscopy-protected specimen brush(FOB-PSB) assisted etiological diagnosis in children with severe mycoplasma pneumonia.Methods A study was conducted on 100 children with severe mycoplasma pneumonia admitted to Yellow River Sanmenxia Hospital from May 2022 to August 2023,using FOB-PSB,electronic bronchoalveolar lavage sampling(PBAL),and conventional sputum retention sampling methods.The positive detection rates and pathogen detection rates of the three sampling methods were analyzed;And conduct drug sensitivity tests on Gram negative and Gram positive bacteria to analyze the average resistance rate and sensitivity of Gram negative and Gram positive bacteria;Simultaneously evaluate the clinical treatment effect of positive patients adjusted for antibacterial drugs through drug sensitivity testing.Results The positive detection rate of the FOB-PSB sampling method was 93.00%,which was higher than that of the PBAL sampling method and conventional sputum retention method(79.00%,62.00%),and the PBAL sampling method was higher than the conventional sputum retention method,the differenced were statistically significant(P<0.05).The three sampling methods were mainly Gram-negative bacteria;the detection rate of Gram-negative bacteria by FOB-PSB sampling method was 88.17%,which was significantly higher than that of the PBAL sampling method and conventional sputum retention method(73.42%,64.52%),the difference was statistically significant(P<0.05).Gram-negative bacteria had high resistance to ampicillin,cefazolin,ceftriaxone and quinolones,and high sensitivity to imipenem,piperacillin,amikacin,aztreonam and tigecycline.Gram-positive bacteria were highly resistant to β-lactams and penicillin,and were highly sensitive to linezolid,rifampicin and vancomycin.The average drug resistance rate and average sensitivity of Gram-negative bacteria and Gram-positive bacteria of the FOB-PSB sampling method were higher than those of the PBAL sampling method and conventional sputu

关 键 词：经支气管镜防污染毛刷取样 辅助病原学诊断 儿童 支原体肺炎 

分 类 号：R446.5[医药卫生—诊断学] R725.6[医药卫生—临床医学]