新型经电子纤维支气管镜下防污染支气管肺泡灌洗、支气管肺泡灌洗以及常规痰检法在肺部感染诊治中的应用

Application value of new type of electronic fiberoptic bronchoscope for anti-contamination bronchoalveolar lavage, bronchoalveolar lavage and routine sputum detection in the diagnosis and treatment of pulmonary infection

目的分析新型经电子纤维支气管镜下防污染支气管肺泡灌洗(PBAL)、支气管肺泡灌洗(BAL)以及常规痰检法在肺部感染诊治中的应用价值。方法随机选取2016年1月至2017年10月于合肥市第二人民医院住院的肺部感染者共85例,入组患者均行PBAL、BAL以及常规痰检法,并结合影像学检测。分析以上3种方法病原菌检出率和治疗总有效率。结果85例患者共收集255份标本,培养出病原菌163株,总阳性率为63.92%,其中行PBAL法、BAL法与常规痰检法的病原菌检出率分别为80.00%(68/85)、67.06%(57/85)和44.70%(38/85)。PBAL法与常规痰检法的病原菌检出率差异有统计学意义(χ^2=12.582、P<0.001),而与BAL法的病原菌检出率差异无统计学意义(χ^2=1.570、P=0.210),BAL法与常规痰检法的病原菌检出率差异有统计学意义(χ^2=5.363、P=0.021)。三种方法检出革兰阴性菌占病原菌总数的69.33%(113/163),革兰阳性菌占病原菌总数的24.54%(40/163),真菌占病原菌总数6.13%(10/163)。PBAL法、BAL法以及常规痰检法取样后药敏试验结果显示,革兰阴性菌平均耐药率为(87.34±5.52)%、(76.13±6.33)%和(66.65±4.85)%,差异有统计学意义(F=115.531、P<0.001);平均敏感度为(82.12±4.79)%、(72.54±6.14)%和(62.74±4.65)%,差异有统计学意义(F=114.712、P<0.001)。PBAL法、BAL法以及常规痰检法取样后药敏试验结果显示,革兰阳性菌平均耐药率分别为(85.45±5.13)%、(73.24±4.87)%和(65.37±5.13)%,差异有统计学意义(F=54.626、P<0.001);平均敏感度分别为(80.56±4.67)%、(69.42±4.65)%和(61.34±4.25)%,差异有统计学意义(F=61.114、P<0.001);68例细菌培养呈阳性患者根据以上三种取样方法进行药敏试验调整抗菌药物治疗后,PBAL法总有效率为88.24%(56/68),显著高于BAL法[73.68%(42/57)]和常规痰检法[52.63%(20/38)],差异均有统计学意义(χ^2=4.372、P=0.036,χ^2=16.692、P<0.001);BAL法总有效率则显著高于常规痰检(73.68%vs.52.63%),差异有统计学意义(χ^2=4.458、P=0.035);PBAL法总有效率显著高于BAL法(88.24%vs.73.68%)差异有统计学意义(χ^2=4.372、P=0.036)。结论PBAL与BAL法的病原学检测率与治疗总有效率均高于常规痰检,且PBAL法取样后经药敏试验调整抗菌药物后的治疗总有效率高于BAL法,故PBAL法具有更高的应用价值。

Objective To investigate the application value of anti-contamination bronchoalveolar lavage(PBAL),bronchoalveolar lavage(BAL)and routine sputum detection in the diagnosis and treatment of pulmonary infection by electronic fiber bronchoscopy.Methods Total of 85 patients with pulmonary infection admitted to Hefei Second People’s Hospital from January 2016 to October 2017 were selected,randomly.All patients underwent PBAL,BAL and routine sputum detection,also combined with image detection.The detection rate of pathogenic bacteria and the total effective rate after clinical treatment were analyzed by the above three methods.Results A total of 255 specimens were collected from 85 patients,and 163 strains of pathogens were cultured.The total positive rate was 63.92%.The detection rates of PBAL,BAL and routine sputum detection were 80.00%(68/85),67.06%(57/85)and 44.70%(38/85),respectively.The detection rates of pathogens by PBAL method and routine sputum detection were significantly different(χ^2=12.582,P<0.001),but without significant difference compared with the detection rate of pathogens by BAL method(χ^2=1.570,P=0.210).The detection rate of pathogens by BAL method and routine sputum detction were significantly different(χ2=5.363,P=0.021).Gram-negative bacteria accounted for 69.33%(113/163),Grampositive bacteria accounted for 24.54%(40/163),and fungi accounted for 6.13%(10/163)of the total number of pathogens by three methods.The results of drug sensitivity test after sampled by PBAL,BAL and routine sputum showed that the average resistance rates of Gram-negative bacteria were(87.34±5.52)%,(76.13±6.33)%and(66.65±4.85)%,with significant difference(F=115.531,P<0.001);the average sensitivity were(82.12±4.79)%,(72.54±6.14)%and(62.74±4.65)%,with significant difference(F=114.712,P<0.001).The results of drug sensitivity test after sampled by PBAL,BAL and routine sputum showed that the average resistance rates of Gram-positive bacteria were(85.45±5.13)%,(73.24±4.87)%and(65.37±5.13)%,with significant difference(F=54.626,P<0.001);while the average sensitivity were(80.56±4.67)%,(69.42±4.65)%and(61.34±4.25)%,with significant difference(F=61.114,P<0.001).Total of 68 patients with positive bacterial culture were tested for antimicrobial susceptibility according to the above three sampling methods,the total effective rate of PBAL was 88.24%(56/68),which was significantly higher than that of BAL[73.68%(42/57)]and routine sputum detction[52.63%(20/38)],with significant difference(χ^2=4.372,P=0.036;χ^2=16.692,P<0.001).The total effective rate of BAL method was significantly higher than that of the routine sputum detection(73.68%vs.52.63%;χ^2=4.458,P=0.035).The total effective rate of PBAL was significantly higher than that of BAL(88.24%vs.73.68%),with significant difference(χ^2=4.372,P=0.036).Conclusions The pathogenic detection rate and total effective rates of anti-pollution tracheal alveolar lavage and anti-contamination tracheal lens alveolar lavage sampled by drug susceptibility test after adjusting antibacterial drugs,the total effective rate is higher than of BAL.The total effective rate of anti-pollution PBAL is higher than that of BAL,suggesting that it has higher application value.