两种标本采集方法对ICU患者下呼吸道病原学检测的影响

Effect of two methods of specimen collection for etiology detection of lower respiratory tract in ICU patients

目的比较两种标本采集方法获取的ICU患者下呼吸道样本的病原学检测结果,以确定何种方法可更准确简便地获取标本,为临床治疗提供依据。方法选取40例来自ICU的急危重症患者。对同一患者先以无创常规方法采集下呼吸道标本密封,再以纤支镜(Olympus BF P40)获取支气管肺泡灌洗液(BALF)密封后同时送检。结果经无创常规获取痰标本的痰培养阳性率为72.5%,经纤支镜获取BALF的培养阳性率为80.0%,两组阳性率比较,差异无统计学意义(P>0.05);两组培养结果符合率为72.5%(29/40),两种样本采集方法获取的样本中病原菌检测结果具有一致性(Kappa=0.658,P=0.000)。结论无创常规标本采集方法仍然是一种省时、省力、经济且较准确的获取高质量样本的方法。

Objective To compare the results of two methods of specimen collection for etiology detection of lower respiratory tract in ICU patients,and to identify the more accurate and simple method of specimen collection so as to provide evidence for clinical practice.Methods 40 cases of critical patients were selected from ICU. Specimen of lower respiratory tract of the same patient was first collected with noninvasive conventional method and sealed,then obtained from bronchoalveolar lavage fluid( BALF) by fiber bronchoscopy( Olympus BF P40) and sealed,and the two specimens were inspected at the same time. Results The positive rate of sputum culture by noninvasive conventional method was 72. 5%,while the positive rate of BALF culture by bronchoscopy was 80. 0%,and there was no statistically significant difference between positive rates of the two methods( P > 0. 05). The coincidence rate of specimen sputum culture by the two methods was72. 5%,and the results of pathogen inspection of the two specimens also had consistency( Kappa = 0. 658,P = 0. 000). Conclusion The conventional noninvasive method is still a time- and effort- saving,economical and accurate method for high- quality specimen collection of lower respiratory tract.