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作 者:代芊[1] 邓宏[2] 周涌[2] 宁涛[1] 李剑峰
机构地区:[1]第四军医大学吉林军医学院军队卫生学教研室,吉林吉林132013 [2]第四军医大学吉林军医学院附属医院泌尿外科,吉林吉林132013
出 处:《第四军医大学学报》2004年第1期50-52,共3页Journal of the Fourth Military Medical University
基 金:军队"九五"青年基金 (98Q0 30 )
摘 要:目的 :验证胃→食道→咽→下呼吸道逆行感染途径存在与否 ,研究胃液 pH值变化与医院获得性肺炎 (hospitalacquiredpneumonia,HAP)发生的关系 .方法 :以气管切开或插管患者为研究对象 ,用防污染标本刷 (PSB)采集标本 ,由细菌表型分型 ,直至质粒DNA图谱、酶切图谱、全基因组DNA稀有位点酶切脉冲电场电泳 (genomemacrorestriction pulsedfieldgelelectrophosresis,GM PFGE)等基因分型方法 ,前瞻性观察NP的发生情况 .结果 :1 1例患者有逆行感染存在 (发生率为 2 2 % ) ,即在胃部分离出病原菌 1~ 2d后 ,PSB在咽部及下呼吸道也检出相同的细菌 ,应用上述分子生物学技术进行同源性分析 ,证明其有很高的同源性 .聚类分析相似系数为1 0 0 % .将美蓝经胃管注入患者胃内 ,1~ 2d后在咽部及下呼吸道可检出蓝色分泌物 .随着胃液 pH值升高 ,胃内细菌定植增加 ,NP的发生率升高 .结论 :证明存在胃→食道→咽→下呼吸道逆行感染途径 ,且NP的发生与胃液pH值显著相关 (r=0 .70 87,P <0 .0 1 ) .AIM: To explore the evidence of retrograde route of transmission from stomach to oropharynx to lower respiratory tract and investigate the relationship between the incidence of nosocomial pneumonia and the pH value of stomch. METHODS: The study was conducted in patients in department of neurology and neural surgery of three teaching hospitals requiring mechanical ventilation or tracheostomy,the secretion of lower respiratory tract was collected by protected specimen brush (PSB) and the specimens were carried out for quantitative culture of bacteria. At the same time, the bacterial samples of gastric aspirates were collected to culture and the pH value of gastric aspirates was determined using a digital acid base analyzer. All patients were monitored for development of nosocomial pneumonia every two days. The gene typings of the bacterial from lower respiratory tract secretion and gastric aspirates were taken by plasmial profile analysis,restriction andonuclease fingerprint analysis and Genome Macrorestriction Pulsed Field Gel Electrophoresis (GM PFGE) in the same phenotype bacteria. RESULTS: In 11(22%) case of nosocomial pneumonia, the identical organisms were isolated first in the gastric samples and then one to two days later in tracheal secretion. They were very homologous,exhibiting the same fingerpriting in plasmid profile, endonuclease fingerprint and GM PFGE. Two days after being perfused into the stomach through masogastric tubes, Methylene blue was found in the secretion of throat and lower respiratory tract. The bacterial counts in gastric aspirates increased significantly with gastric pH. CONCLUSION: The retrograde route of transmission is confirmed to be existed and it is one of the risk factors in nosocomial pneumonia.The occurrence of nosocomial pneumonia is significantly associated with the rising of gastric pH.
关 键 词:GM—PFGE图谱分析 医院获得性肺炎 逆行感染
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