改良法防污染毛刷在小儿难治性肺炎中应用价值的探讨

Value of Modified ＊ Protective Specimen Brush in Refractory Pneumonia in Children

【目的】比较痰培养、改良法防污染毛刷（PSB）和支气管肺泡灌洗液（BALF）三种不同取材方法细菌培养的敏感性、准确性，以探讨改良法防污染毛刷对小儿难治性肺炎病原学诊断的价值。【方法】对200例难治性肺炎患儿，每一例均先后使用以上三种不同方法收集标本，细菌培养后进行比较。【结果】改良法防污染毛刷、痰、BALF三种取材方法的细菌培养阳性率分别为37％、23％、35％。改良毛刷取材培养和BALF培养的阳性率明显高于痰培养（P〈O．05）。并且，改良法防污染毛刷和BALF的培养结果均以革兰阴性菌为主，两者符合率高。【结论】痰培养与改良法防污染毛刷和BALF比较，细菌培养结果的准确性和敏感性均有一定差距。改良法防污染毛刷法细菌培养结果的准确性和敏感性高，有助于难治性肺炎致病菌的正碓判断和抗生素的合理选择。

[Objective]To compare the sensitivity and accuracy of three different sampling methods of bac- terial culture including sputum culture, modified protective specimen brush（PSB） and bronchoalveolar lavage fluid（BALF） in order to explore the value of modified PSB in pathogen diagnosis of refractory pneumonia in children. [Methods] The samples of 200 pediatric patients with refractory pneumonia were collected by using three above different methods. After bacterial culture, the results were compared. [Results]The bacterial cul- ture positive rate of modified PSB, sputum and BAL were 37%, 23% and 35%, respectively. The positive rate of modified PSB culture and BALF were significantly higher than that of sputum culture（ P d0.05）. The results of modified PSB and BALF were mainly gram negative bacteria, and the coincidence of both two meth- ods was high. [Conclusion]Compared with modified PSB and BALF, the accuracy and sensitivity of bacterial culture of sputum culture are lower. The accuracy and sensitivity of modified PSB are high. Therefore, the modified PSB is helpful for the correct judgement of pathogens and rational choice of antibiotic for refractory pneumonia.