经鼻和经气管插管支气管肺泡灌洗在病原学诊断及耐药率监测中的应用比较

Compare bronchoalveolar lavage via nasal or tracheal cannula in pathogenic diagnosis and drug resistance rate monitoring of pulmonary infection

目的通过比较经鼻和经气管插管行支气管肺泡灌洗培养的病原菌检测及耐药特征,探索支气管肺泡灌洗在诊断肺部感染病原学及耐药率监测中的应用。方法回顾性分析比较2013年1月—2015年12月广西医科大学第四附属医院各科肺部感染住院患者经鼻和经气管插管行支气管肺泡灌洗(BAL)培养的病原菌检测及耐药率情况,用SPSSS 19.0及WHONET 5软件进行数据统计分析。结果 3年期间行支气管镜纤维支气管肺泡灌洗1 332例,其中经鼻BAL(A组)207例、经气管插管BAL(B组)1 125例,ICU+神经外科监护室占标本总量84.5%。2组灌洗液涂片合格率及致病菌检出率差异均无统计学意义(P>0.05)。除了鲍曼不动杆菌外,2组病原菌的分布构成比差别不大(P>0.05),但2组分离的病原菌对常用抗菌素的耐药率有所差别。结论经鼻和经气管插管行支气管肺泡灌洗BAL涂片合格率及致病菌检出率均无差别,经鼻和经气管插管行支气管肺泡灌洗对肺部感染病原学的诊断和耐药率监测均具有较高的临床应用价值。

Objective To investigate the value of bronchoalveolar lavage（BAL） via nasal or tracheal cannula in patho- genic diagnosis and drug resistance rate monitoring of pulmonary infection （PI）. Methods We conducted a retrospective analysis of pathogenic detection and drug resistance rate by bronchoalveolar lavage via nasal or tracheal cannula in pa- tients with PI from 2013 to 2015 ;the data were analyzed by SPSS 19.0 and WHONET 5 software. Results Total 1 332 patients with pulmonary infection underwent hronchoalveolar lavage by fiberoptic bronchoscopy in 3 years,207 cases via nasal（ A group） and 1 125 cases via tracheal cannula（ B group）, and 84.5% of specimens were in the Intensive Care U- nit （ICU） and neurosurgery ward. The qualification rates were similar in the 2 groups ,which were 99.0% and 99.6% , respectively （ P 〉 0.05 ） ; the pathogenic detecting rate of bronchoalveolar lavage fluid （BALF） were also similar between the 2 groups ,with an 85.5% and 86.9%, respectively （P 〉 O. 05 ）. The pathogenic distributions were similar except Acinetobacter spp, however, drug resistant rates to most antibiotics were different between the 2 groups （ P 〉 O. 05 ）. Con- clusions Both of transnasal or transtracheal cannula bronchoalveolar lavages are a high value approach in the pathogenic diagnosis and drug resistance monitor of pulmonary infection.