本文關鍵詞： 纖維支氣管鏡保護性毛刷 保護性毛刷盲取技術 細菌定量培養(yǎng) 肺部感染　出處：《鄭州大學》2012年碩士論文　論文類型：學位論文

【摘要】：目的： 探討纖維支氣管鏡保護性毛刷及保護性毛刷盲取技術結合細菌定量培養(yǎng)在重癥肺部感染病原學診斷中的臨床應用價值。 方法： 選取2010年10月至2012年1月收住鄭州大學第一附屬醫(yī)院呼吸暨重癥醫(yī)學科重癥監(jiān)護病房(RICU)的重癥肺部感染并行氣管插管或氣管切開機械通氣的患者65例。先后同期應用纖維支氣管鏡保護性毛刷(FOB-PSB)、保護性毛刷盲取(BPSB)和一次性吸痰管采集下呼吸道分泌物進行細菌定量培養(yǎng)(QC),對三種方法分離的細菌種類,致病菌陽性率,污染率進行對比,并觀察根據(jù)藥敏試驗結果應用抗生素后治療的有效率。 結果： (1)采集195份標本,每份標本統(tǒng)計出1株優(yōu)勢菌,共分離出病原菌163株,陽性率83.6%。將表皮葡萄球菌、產(chǎn)黑色素桿菌視為污染菌排除,則分離出致病菌陽性率70.8%。培養(yǎng)結果以革蘭陰性桿菌占首位(119株,73%),其中以銅綠假單胞菌、肺炎克雷伯菌及鮑曼不動桿菌為主要病原菌：革蘭陽性球菌占第2位,以金黃色葡萄球菌為主。 (2)不同采樣方法細菌檢出株數(shù)為纖維支氣管鏡保護性毛刷結合細菌定量培養(yǎng)(FOB-PSB-QC)58株(89.2%),保護性毛刷盲取術結合細菌定量培養(yǎng)(BPSB-QC)54株(83.1%),普通抽痰法51株(78.5%)。三者陽性率相比較無明顯統(tǒng)計學意義(P均0.05)。將表皮葡萄球菌和產(chǎn)黑色素桿菌作為非致病菌予以剔除,致病菌的分離例數(shù)為FOB-PSB-QC57株(87.7%),BPSB-QC53株(81.5%),普通抽痰法28株(43.1%)。 (3)致病菌檢出陽性率相互比較：FOB-PSB-QC與BPSB-QC比較差異不大,無明顯統(tǒng)計學意義(P=0.33),FOB-PSB-QC與普通抽痰法及BPSB-QC與普通抽痰法比較差異較大,有統(tǒng)計學意義(P0.01)。培養(yǎng)出的163株陽性菌中污染菌25株(15.3%),FOB-PSB-QC1株(1.7%),BPSB-QC1株(1.8%),普通抽痰23株(45%),三種方法的防污染性能相比較：FOB-PSB-QC與BPSB-QC無明顯統(tǒng)計學意義(P=0.7),FOB-PSB-QC與普通抽痰法及BPSB-QC與普通抽痰法比較,差異有統(tǒng)計學意義(P0.01)。對三組檢測出的致病菌分布情況相比較差異均無統(tǒng)計學意義(P均0.05)。如果以FOB-PSB-QC為參照標準,BPSB-QC的敏感性82.8%,陽性預測值88.9%,兩者分離出的細菌分布一致性為84.6%。常規(guī)痰細菌培養(yǎng)與之的一致性48.3%。 結論： (1)經(jīng)纖維支氣管鏡保護性毛刷取樣結合細菌定量培養(yǎng)技術,能直達肺部感染灶,敏感性及特異性,防污染性能均明顯優(yōu)于常規(guī)檢查方法,其安全性高,對于RICU中重癥肺部感染患者可常規(guī)使用。 (2)保護性毛刷盲取技術與經(jīng)纖維支氣管鏡保護性毛刷取樣有相近的敏感性及特異性,且耗時短,費用低,對技術性要求稍低,可在臨床推廣使用。 (3)常規(guī)取痰技術與上述兩種技術相比,雖然有弊端,但由于其風險更小費用更低,對技術要求更低,仍可繼續(xù)應用,但操作過程中應注意無菌操作,盡量減少污染。
[Abstract]:Objective:. To explore the clinical value of fiberoptic bronchoscope protective brush and blind extraction of protective brush combined with bacterial quantitative culture in the etiological diagnosis of severe pulmonary infection. Methods:. From October 2010 to January 2012, 65 patients with severe pulmonary infection receiving tracheal intubation or tracheotomy mechanical ventilation in the Department of Respiratory and intensive Care Unit (ICU) of the first affiliated Hospital of Zhengzhou University were selected. The protective brush FOB-PSBP with fiberoptic bronchoscope, the BPSBs with the protective brush and the lower respiratory tract secretions were collected with a disposable sputum suction tube for quantitative culture. The bacteria were isolated by three methods. The positive rate and contamination rate of pathogenic bacteria were compared, and the effective rate of antibiotic treatment was observed according to the results of drug sensitivity test. Results:. 1) A total of 195 specimens were collected. One dominant strain was found in each specimen, 163 of which were isolated, and the positive rate was 83.6. Staphylococcus epidermidis and melanin producing bacillus were excluded as polluting bacteria. The positive rate of pathogenic bacteria was 70.8%. The results showed that gram-negative bacilli were the first strain of 73 strains. Among them, Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii were the main pathogens: Gram-positive coccus was the second. Staphylococcus aureus is the main. (2) the number of bacteria detected by different sampling methods was as follows: fiberoptic bronchoscope protective brush combined with bacterial quantitative culture (FOB-PSB-QC) 58 strains, protective brush blind extraction combined with bacterial quantitative culture (BPSB-QCU 54 strain), common sputum extraction method (51 strains) 78.55.The positive rates of the three were compared. Staphylococcus epidermidis and melanin producing bacillus were excluded as non-pathogenic bacteria. The isolated cases of pathogenic bacteria were FOB-PSB-QC57 strain 87.7 and BPSB-QC53 strain BPSB-QC53, which were 81.5 and 43.1, respectively. (3) the positive rate of detecting pathogenic bacteria was not significantly different from that of BPSB-QC. There was no significant difference between FOB-PSB-QC and ordinary sputum extraction method, and there was a great difference between BPSB-QC and common sputum extraction method, and there was no significant difference between FOB-PSB-QC and common sputum extraction method. 25 strains of contaminated bacteria were isolated from 163 strains of positive bacteria, 25 strains were found to be infected by FB-PSB-QC1 strain, and 1.78 strains of BPSB-QC1 strain were isolated from normal sputum, and 23 strains from common sputum extraction were compared with the normal sputum extraction method. There was no significant difference between the three methods in the prevention of pollution compared with BPSB-QC and FOB-PSB-QC method, and BPSB-QC compared with the ordinary sputum extraction method. There was no significant difference in the distribution of pathogenic bacteria between the three groups. If the sensitivity of BPSB-QC was 82.8 and the positive predictive value was 88.9, the distribution of bacteria isolated from the two groups was as follows: (1) the sensitivity of BPSB-QC was 82.8%, and the positive predictive value was 88. 9%. The sensitivity of sputum was 84.6. The consistency of bacterial culture with routine sputum was 48.3%. Conclusion:. 1) sampling of protective brush with fiberoptic bronchoscope combined with bacterial quantitative culture technique can direct to pulmonary infection foci, its sensitivity, specificity and anti-pollution performance are obviously superior to those of conventional methods, and its safety is high. It can be used routinely in patients with severe pulmonary infection in RICU. (2) Blind extraction of protective brushes has similar sensitivity and specificity to that of fiberoptic bronchoscopic brushes, short time consuming, low cost, low technical requirements, and can be popularized in clinical practice. 3) the conventional sputum extraction technique has disadvantages compared with the above two techniques, but because of its lower risk, lower cost and lower technical requirement, it can still be applied continuously, but it should pay attention to the aseptic operation and minimize the pollution during the operation.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R563.1

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