中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2009年
12期
915-918
,共4页
刘瑞贞%徐德祥%孙荣丽%李黎
劉瑞貞%徐德祥%孫榮麗%李黎
류서정%서덕상%손영려%리려
肺炎%呼吸机相关性%诊断%保护性毛刷
肺炎%呼吸機相關性%診斷%保護性毛刷
폐염%호흡궤상관성%진단%보호성모쇄
Pneumonia%ventilator-associated%Diagnosis%Protected specimen brush
目的 评价盲法远端插入双腔导管采样(PTC)与支气管镜下保护性毛刷(PSB)对呼吸机相关性肺炎(VAP)病原学诊断的价值.方法 收集2008年1月至2009年2月青岛大学医学院第二附属医院内科ICU住院的69例怀疑VAP的机械通气患者,入选标准为首次住院时间超过48 h、接受过机械通气治疗并怀疑VAP的患者,均进行PSB和PTC检查,所有检杳结果均按照≥10~6 CFU/L标准进行阳性评判,若标本中出现草绿色链球菌、淡黄色奈瑟球菌则考虑标本污染而剔除.结果 所取标本先经革兰染色涂片光镜下判定,69例中PTC和PSB方法检查结果的阳性例数分别60例(87.O%)和58例(84.1%).所有标本均进行细菌培养,以PSB为金标准,PTC的敏感度为82.1%,特异度为92.7%,阳性预测值为88.5%,阴性预测值为88.4%.结论 对于近期进行机械通气的患者,如果怀疑VAP但没有条件进行PSB或支气管肺泡灌洗时,PTC是一种有价值的检测方法.
目的 評價盲法遠耑插入雙腔導管採樣(PTC)與支氣管鏡下保護性毛刷(PSB)對呼吸機相關性肺炎(VAP)病原學診斷的價值.方法 收集2008年1月至2009年2月青島大學醫學院第二附屬醫院內科ICU住院的69例懷疑VAP的機械通氣患者,入選標準為首次住院時間超過48 h、接受過機械通氣治療併懷疑VAP的患者,均進行PSB和PTC檢查,所有檢杳結果均按照≥10~6 CFU/L標準進行暘性評判,若標本中齣現草綠色鏈毬菌、淡黃色奈瑟毬菌則攷慮標本汙染而剔除.結果 所取標本先經革蘭染色塗片光鏡下判定,69例中PTC和PSB方法檢查結果的暘性例數分彆60例(87.O%)和58例(84.1%).所有標本均進行細菌培養,以PSB為金標準,PTC的敏感度為82.1%,特異度為92.7%,暘性預測值為88.5%,陰性預測值為88.4%.結論 對于近期進行機械通氣的患者,如果懷疑VAP但沒有條件進行PSB或支氣管肺泡灌洗時,PTC是一種有價值的檢測方法.
목적 평개맹법원단삽입쌍강도관채양(PTC)여지기관경하보호성모쇄(PSB)대호흡궤상관성폐염(VAP)병원학진단적개치.방법 수집2008년1월지2009년2월청도대학의학원제이부속의원내과ICU주원적69례부의VAP적궤계통기환자,입선표준위수차주원시간초과48 h、접수과궤계통기치료병부의VAP적환자,균진행PSB화PTC검사,소유검묘결과균안조≥10~6 CFU/L표준진행양성평판,약표본중출현초록색련구균、담황색내슬구균칙고필표본오염이척제.결과 소취표본선경혁란염색도편광경하판정,69례중PTC화PSB방법검사결과적양성례수분별60례(87.O%)화58례(84.1%).소유표본균진행세균배양,이PSB위금표준,PTC적민감도위82.1%,특이도위92.7%,양성예측치위88.5%,음성예측치위88.4%.결론 대우근기진행궤계통기적환자,여과부의VAP단몰유조건진행PSB혹지기관폐포관세시,PTC시일충유개치적검측방법.
Objective To compare the diagnostic value of blind double-lumen plugged telescoping catheter( PTC) and protected specimen brush(PSB) in patients requiring mechanical ventilation ( MV) for suspected ventilation-associated pneunonia( VAP). Methods Sixty-nine patients with a hospital stay of ≥ 48 h who required MV for suspicion of VAP were prospectively enrolled in the study during Jan 2008 and Feb 2009 in the medical intensive care unit. The patients all underwent bronchial samplings: a blind PTC and a fiberoptic PSB were performed successively in each case. A positive culture for both sampling procedures was defined as the recovery of ≥ 10~6 CFU/L of at least one potential pathogen. Results The overall specimen were judged by film preparation through the microscopic examination. The positive result of PTC and PSB were 60(87. 0% )and 58 (84. 1% ) respectively. Bacterial culture was performed for all the specimen and PSB was regarded the golden standard. PTC had a sensitivity of 82. 1 % , a specificity of 92. 7% , a positive predictive value of 88. 5% , and a negative predictive value of 88. 4%. Conclusion PTC may be a reliable alternative to the newly mechanically ventilated patients with suspicion of VAP.
