床边纤维支气管镜检查在可疑院内获得性肺炎诊断中的意义

Utility of bed-side fiberoptic bronchoscopy in the diagnosis of the pat ients with suspected nosocomial pneumonia

目的 评价床边纤维支气管镜检查在可疑院内获得性肺炎诊断中的意义。 方法 对 2 5例可疑院内获得性肺炎患者进行床边纤维支气管镜检查 ,同时进行痰标本和支气管肺泡灌洗液标本涂片细菌检测和培养。 结果 1例为肺出血 ,2例肺不张 ,1例肺水肿 ;2 1例为院内获得性肺炎 ,其中 14例 (72 .7% )细菌培养阳性 ,革兰阴性杆菌占 5 7.1% (12 / 2 1) ,以铜绿假单胞菌、不动杆菌属、嗜麦芽假单胞菌、肺炎克雷伯菌最常见 ,革兰阳性球菌 2例 (9.5 % ) ,主要是耐甲氧西林金黄色葡萄球菌。痰涂片和支气管肺泡灌洗液涂片阳性者分别为 3例和 10例。支气管肺泡灌洗液细菌涂片阳性率和细菌培养阳性率均高于痰标本 (P =0 .0 2和P =0 .0 0 5 )。 结论 床边纤维支气管镜检查有助除外疑似院内获得性肺炎的非感染性疾病。支气管肺泡灌洗液标本病原学检测优于痰标本。

Objective To evaluate the value and safety of b ed -side fiberoptic bronchoscopy in the diagnosis of the patients with suspected n osocomial pneumonia (NP). Methods Bed-side fiberoptic bronch oscopy was performed in 25 cases who clinically diagnosed as NP.Meantime,sputum samples and bronchoalveolar lavage fuids(BALF) were collected, smeared and incub ated for pathogens identification. Results Of 25 cases,one c ase was identifed as pulmonary hemorrhage,two cases as atelectasis,one case as p ulmonary edema, and 21 cases as NP.Of 21 NP cases,the strains of pathogens were identified in 14 cases.Gram-negative bacilli accounted for 57.%(12/21),includi ng Pseudomonas aeruginasa,Candida albicans,Acinetobacter baumann ii and Klebsiella pneumoniae.Gram-positive germs accoun ted for 9.5%(2/21).The positive detection of smear was 3 cases in sputum sample, and 10 cases in BALF.The positive rates of both Gram stain and pathogens identi fication in BALF were significantly higher than those in the sputum samples ( P=0.02 and P=0.005, respectively). Conclusion Bed-side fiberoptic bronchoscopy for NP patients is safe and helpful to exclu de simulated diseases such as pulmonary hemorrhage,atelectasis,pumonary edema, e tc.BALF is superior to sputum sample in pathogens detection. <