摘要
目的探讨纤维支气管镜(纤支镜)防污染毛刷(PSB)取痰液标本培养在机械通气重症肺部感染患者病原学诊断中的价值,探讨机械通气联合纤支镜吸痰及支气管肺泡灌洗术治疗重症肺部感染的安全性及临床效果。方法选取74例重症肺部感染应用有创机械通气患者,将其分为治疗组和对照组。对照组机械通气37例使用无菌吸痰管吸取下呼吸道分泌物,治疗组37例在机械通气下接受纤支镜PSB取得患者下呼吸道标本,两组标本均进行病原菌分离培养鉴定及药敏试验,并行纤支镜下吸痰及支气管肺泡灌洗术。结果对照组与治疗组采样培养的阳性率分别为70.27%和75.68%(P>0.05),联合纤支镜吸痰及支气管肺泡灌洗术治疗前后,患者pH改善、PaO2升高、PaCO2下降、SaPO2升高、心率和呼吸平稳;纤支镜下吸痰及支气管肺泡灌洗术治疗组总有效率明显提高;机械通气时间及住院时间明显缩短(P<0.01)。结论无菌吸痰管采样对于机械通气合并下呼吸道感染患者,能获得准确的病原学资料,是一种简单、安全和经济的病原采集方法。机械通气联合纤支镜下吸痰及支气管肺泡灌洗术治疗重症肺部感染疗效确切,术中危险性小,值得推广。
Objective To compare the diagnostic value of sterile sputum suction tube with protected specimen brush in mechanically ventilated patients with serious lung infection,and explore the safety and efficacy of bronchofibroscope combining mechanical ventilation in the treatment of severe lung infection.Methods Seventy-four severe lung infection patients with invasive mechanical ventilation support were recruited in the study.Based on the routine treatment,the subjects were randomly divided into a control group received only mechanical ventilation,and a treatment group received sputum aspiration and bronchial lavage by bronchofibroscope combining mechanical ventilation.Lower respiratory tract secretion was collected to analyze the bacterial etiology with sterile sputum suction tube in the control group,and with protected specimen brush in the treatment group.Results The positive rate of sputum suction tube and protected specimen brush was 70.27% and 75.68%,respectively,with no statistical difference between the two groups(P>0.05).The PaO2 of the treatment group increased and PaCO2 decreased obviously after sputum aspiration and bronchial lavage by bronchofibroscope(P<0.01).The total effective rate was also highly increased,and the heart rate and respiration were stable in the treatment group.The time of mechanical ventilation and the length of ICU stay were all shortened in the treatment group compared with the control group.Conclusions Sterile sputum suction tube can not only acquire accurate pathogen,but also is a simple and economical method for patients with severe lung infection with mechanical ventilation.Sputum aspiration and bronchial lavage with bronchofibroscope combining mechanical ventilation are effective and safe treatment for patients with severe lung infection.
出处
《中国呼吸与危重监护杂志》
CAS
2011年第3期237-240,共4页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
机械通气
纤维支气管镜
重症肺部感染
防污染毛刷
支气管肺泡灌洗
Mechanical ventilation
Fiberoptic bronchoscopy
Serious lung infection
Protected specimen brush
Bronchoalveolar lavage
