【摘要】：目的：研究纖維支氣管鏡檢查對(duì)熱射病(Heat Stroke HS)患者呼吸道感染早期診斷的價(jià)值,進(jìn)一步提高對(duì)熱射病患者呼吸道感染的早期診斷。方法：選擇我院ICU自2012年5月至2014年7月收治的熱射病患者16例,所有患者均已開(kāi)放氣道,11例行經(jīng)口氣管插管,5例經(jīng)鼻氣管插管。16例患者進(jìn)入ICU后第一天開(kāi)始,每天早晨8:00左右分別用兩種方法采集痰標(biāo)本,分別為常規(guī)吸痰法和纖支鏡吸痰法。兩種采集順序根據(jù)統(tǒng)計(jì)學(xué)完全隨機(jī)化設(shè)計(jì)原則進(jìn)行編號(hào)。常規(guī)采集痰標(biāo)本方法,用吸痰管經(jīng)氣管導(dǎo)管吸痰留取標(biāo)本；纖支鏡法采集痰標(biāo)本,患者仰臥,使用多功能心電監(jiān)護(hù),連續(xù)監(jiān)測(cè)患者心率、血壓、呼吸頻率及血氧飽和度,躁動(dòng)患者適當(dāng)鎮(zhèn)靜,進(jìn)行纖維支氣管鏡檢查,跨越聲門(mén)后,在分泌物最多處吸取分泌物致無(wú)菌積痰器,將積痰器送檢驗(yàn)科做細(xì)菌培養(yǎng)加藥敏試驗(yàn)。結(jié)果：(1)、16例熱射病患者在進(jìn)入ICU后24小時(shí)內(nèi)痰培養(yǎng)均未培養(yǎng)出細(xì)菌；48小時(shí)內(nèi)不同程度檢出細(xì)菌,常規(guī)法占6%,纖支鏡法占120%，顯著高于常規(guī)組。(2)、纖支鏡組入ICU第五天、常規(guī)組入ICU第七檢出多重耐藥菌,7天內(nèi)送檢標(biāo)本中共分離培養(yǎng)出多重耐藥菌44株,陽(yáng)性率為78.57%,其中常規(guī)法16株,陽(yáng)性率36.36%；纖支鏡法28株,陽(yáng)性率63.64%,有顯著差異(P0.05)。革蘭氏陰性菌31株(70.46%)常規(guī)法11株(25%),纖支鏡法20株(45.45%),有顯著差異(P0.05)；鮑曼不動(dòng)桿菌為15株(34.09%),常規(guī)法7株(15.9%),纖支鏡法8株(18.18%),無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)；銅綠假單胞13株(29.55%),常規(guī)法7株(15.91%),纖支鏡法6株(13.64%)無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)；大腸埃希菌4株(9.09%)；革蘭氏陽(yáng)性菌10株(22.73%),常規(guī)法3株(6.8%),纖支鏡法7株(15.91%),有顯著差異(P0.05),主要是金黃色葡萄球菌6株(13.64%)均為纖支鏡組檢出,其他為肺炎鏈球菌和表皮葡萄球菌。結(jié)論：(1)纖維支氣管鏡診斷熱射病患者呼吸道感染方法簡(jiǎn)單、安全,準(zhǔn)確率高；(2)纖支鏡對(duì)病原菌和多重耐藥菌檢出率高于常規(guī)吸痰,但對(duì)病原菌的種類(lèi)檢出無(wú)明顯區(qū)別。
[Abstract]:Objective: to study the value of fiberoptic bronchoscopy in the early diagnosis of respiratory tract infection in patients with heat emitting disease (Heat Stroke HS). Methods: from May 2012 to July 2014, 16 patients with heat emitting disease admitted to our hospital from May 2012 to July 2014 were selected. All patients had open airway, 11 patients had oral tube intubation, 5 patients had nasal endotracheal intubation, 16 patients had been admitted to ICU on the first day. Two methods were used to collect sputum samples about 8:00 each morning: routine sputum aspiration and fiberoptic sputum aspiration. The two collection sequences were numbered according to the principle of complete randomization design of statistics. The sputum specimen was collected by routine method, and the specimen was retained by suction tube through trachea catheter. Sputum samples were collected by fiberoptic bronchoscopy, the patients were supine, multifunctional ECG monitoring was used, the heart rate, blood pressure, respiratory frequency and blood oxygen saturation were continuously monitored, the restless patients were properly sedated, fiberoptic bronchoscopy was performed, and after crossing glottis, The aseptic sputum accumulator caused by the most secretions was collected and sent to the laboratory for bacterial culture and drug sensitivity test. Results: (1) bacteria were not cultured in sputum culture within 24 hours after entering ICU. Bacteria were detected in different degrees in 48 hours, 6 by routine method, 120 by fiberoptic bronchoscopy, significantly higher than those in routine group. (2) on the fifth day of ICU, multidrug resistant bacteria were detected in routine group and ICU 7, respectively. Within 7 days, 44 strains of multidrug resistant bacteria were isolated and cultured, and the positive rate was 78.57. Among them, 16 strains were detected by routine method, and the positive rate was 36.36%. The positive rate of fiberoptic bronchoscopy was 63.64 and there was significant difference (P0.05). There were 31 Gram-negative strains (70.46%), 11 strains (25%) by routine method and 20 strains (45.45%) by fiberoptic bronchoscopy (P0.05). There were 15 strains (34.09%) of Acinetobacter baumannii, 7 strains (15.9%) by routine method and 8 strains (18.18%) by fiberoptic bronchoscopy. There was no statistical difference (P0.05). There were 13 Pseudomonas aeruginosa strains (29.55%), 7 strains (15.91%) by routine method, 6 strains (13.64%) by fiberoptic bronchoscopy (P0.05), 4 strains (9.09%) by Escherichia coli. 10 strains (22.73%) of Gram-positive bacteria, 3 strains (6.8%) of routine methods and 7 strains (15.91%) of fiberoptic bronchoscopy were significantly different (P0.05). Six strains of Staphylococcus aureus (13.64%) were detected by fiberbronchoscopy, the others were Streptococcus pneumoniae and Staphylococcus epidermidis. Conclusion: (1) the method of diagnosing respiratory tract infection by fiberoptic bronchoscopy is simple, safe and accurate. (2) the detection rate of pathogenic bacteria and multidrug resistant bacteria by fiberbronchoscope was higher than that of routine sputum aspiration, but there was no significant difference in the detection of pathogenic bacteria.
【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R594.11;R56

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相關(guān)期刊論文 前1條

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本文編號(hào)：2306599