经气管插管(套管)不同方式取样对呼吸机相关性肺炎病原体的诊断价值.docVIP

经气管插管(套管)不同方式取样对呼吸机相关性肺炎病原体的诊断价值 　　作者：刘坤玲,屈文东,刘伦,于亮　　作者单位：泰山医学院附属泰安医院，山东 泰安 　　【摘要】 目的 探讨经气管插管(套管)气道吸出物定量细菌培养与BALF定量细菌培养对呼吸机相关性肺炎病原体的诊断价值。方法 46例次患者分别先给予经气管插管(套管)气道吸出物细菌培养，后进行支气管肺泡灌洗液细菌培养，比较两种取样方式细菌的种类及耐药性，根据经气管插管(套管)吸出物细菌培养结果，选取敏感抗生素治疗，观察治疗有效率。无效者根据BALF培养结果进行调整，观察治疗有效率。结果 经气管插管(套管)内吸出物和支气管肺泡灌洗液细菌培养，分离1种细菌者分别为23例和17例，2种细菌者21例和23例，3种以上细菌者2例和6例。两种取样方式分离一种细菌的相符率为100%，两种细菌为73%，三种以上为33.3%。根据经气管插管(套管)气道吸出物细菌培养结果，治疗有效率为68.8%，5例治疗无效者根据BALF培养结果重新调整抗生素治疗后，2例有效。结论 气管插管(套管)吸出物细菌培养和药敏实验结果，对于呼吸机相关性肺炎的诊断与治疗有一定指导意义。配合BALF培养和药敏检测，可以进一步提高诊断的准确率和治疗的有效率。 　　【关键词】 支气管肺泡灌洗;呼吸机相关性肺炎;细菌培养 　　Diagnostic value of different sampling methods from Trachea 　　Cannula for ventilator-associated pneumonia 　　LIU Kun-ling，QU Wen-dong，LIU Lun，YU Liang 　　(First Teaching Hospital of Taishan Medical College，Taian 271000，China) 　　Abstract: Objective: To explore diagnostic value of the semi-quantitative geimiculture in airway aspirates and quantitative geimiculture in bronchial alveolar lavage from Trachea Cannula ( intubation ) for the pathogen of ventilator-associated pneumonia. Methods: Forty-six cases were given non-quantitative airway aspirates and bronchial alveolar lavage geimiculture from Trachea Cannula ( intubation )aand the kinds and drug resistence of two sampling methods were compared. Sensitive antibiotics were selected by the results of airway aspirates geimiculture. The effective rate was recorded. The antibiotics was adjusted by the results of BALF gimiculture after the ineffective treatment. Results: Twenty-three cases and 17 cases had one Specie Bacteria，21 and 23 cases had two species bacteria，2 and 6 cases had three Species bacteria in airway aspirates groups and BALF groups respectively. The corresponding rate between the two groups were 100% in one Species Bacteria，73% in two Specie Bacteria，and 33.3% in three Specie Bacteria. The effective rate was 68.8% by the airway aspirates gimiculture. Results: Five ineffectively treated cases were adjusted antibiotics b