3种不同取样方法在诊断ICU人工气道患者肺部感染中的效果比较

Comparative study on effects of three different sampling methods in diagnosis of pulmonary infection in patients with artificial airway in ICU

目的探讨ICU人工气道肺部感染患者先后采用负压吸痰、纤维支气管镜下防污染毛刷(PSB)、纤维支气管镜下肺泡灌洗(BAL)3种病原学取样方法的细菌检出效果.方法选取本院ICU开放人工气道的66例危重症肺部感染患者为研究对象,通过3种不同取样方法获取患者下呼吸道感染部位分泌物,并进行细菌定量培养.对比3种取样方法的细菌检出率.结果66例患者的198份痰培养标本中共分离出92株细菌,阳性率为46.46%,其中以革兰阴性杆菌(G-菌,67.39%)居多,其次是革兰阳性球菌(G+菌,25.00%),最后为真菌(7.61%).PSB、BAL、负压吸痰3种方法的阳性率分别为69.73%、43.96%、25.77%,且3种方法阳性检出率两两比较,差异有统计学意义(P<0.05).结论本院ICU患者当中,铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌引发的肺炎患者比率最高.3种取样方法比较,PSB法获取ICU内人工气道患者下呼吸道感染部位的病原学菌检出率最高,其次为BAL法,而负压吸痰法最低.

Objective To explore clinical effects of negative pressure suction,fiberoptic bronchoscopy anti-contamination brush(PSB),and fiberoptic bronchial alveolar lavage(BAL)in bacterial detection for pulmonary infection patients with artificial airway in ICU.Methods Sixty-six critically ill patients with pulmonary infection undergoing artificial airway in ICU were enrolled.Three different methods were used to obtain the secretion of lower respiratory tract infection sites of artificial airway patients in ICU.The bacteria detection rates of three methods were compared.Results A total of 92 strains of bacteria were isolated from 198 cultured specimens collected from 66 patients,with the positive rate of 46.46%,among which Gram-negative bacilli(G-bacteria)ranked the first(67.39%),followed by Gram-positive cocci(G+bacteria,25.00%),and fungi(7.61%)ranked the last.The positive rates of PSB,BAL and vacuum suction were 69.73%,43.96%and 25.77%,respectively.The three methods including PSB,BAL and vacuum suction showed significant betweengroup differences(P<0.05).Conclusion Among the ICU patients in our hospital,the proportions of patients with pneumonia caused by Pseudomonas aeruginosa,Klebsiella pneumoniae and Acinetobacter baumannii are the highest.Comparison of the three methods shows that PSB obtained the highest detection rate of pathogenic bacteria in the lower respiratory tract infection sites,followed by BAL,and negative pressure is the lowest.