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目的探讨经支气管镜黏膜活检联合细菌定量培养对机械通气下呼吸道耐药菌定植与感染判定的可行性及诊断价值。方法选取河北医科大学第二医院呼吸重症加强治疗病房(RICU)行机械通气且药敏结果提示存在多耐药菌患者50例,依据综合分析原则,分为定植组和感染组。结合患者的一般情况、APACHEⅡ评分、CPIS评分等,比较其临床特征及意义;两组患者均行经支气管镜黏膜活检及细菌定量培养等,分析各方法单项及联合诊断的敏感性和特异性。结果感染组23例,定植组27例,两组患者在机械通气时间、ICU住院时间、尿管留置时间、疾病构成、耐药菌出现前抗生素使用情况等方面均存在显著差异(P<0.05)。动态CPIS评分显示感染组均高于定植组,但仅在插管14 d时有显著性差异(P<0.05)。支气管黏膜活检:感染组炎症反应检出率显著高于定植组(P<0.05)。感染组的炎细胞总数和中性粒细胞计数亦显著高于定植组(P<0.05);细菌定量培养:感染组阳性率明显高于定植组(P<0.05);组织病理与定量培养联合灵敏度和特异度最高,为呼吸及相关下呼吸道感染诊断准确性最佳方法。结论支气管黏膜活检联合细菌定量培养,在鉴别耐药定植菌或感染菌方面诊断价值较高,临床可行性有待进一步大规模证实。缩短机械通气时间、ICU住院时间及尿管留置时间等,有助于减少定植菌的发生。
Objective To investigate the feasibility and diagnostic value of transbronchial mucosal biopsy combined with bacterial quantitative culture in determining the resistance of respiratory tract-resistant bacteria to colonization and infection under mechanical ventilation. Methods Fifty patients with multi-drug resistant bacteria were selected from the Second Hospital of Hebei Medical University for Respiratory Severe Intensive Care Unit (RICU) under mechanical ventilation. According to the principle of comprehensive analysis, the patients were divided into colonization group and infection group. Combined with the general situation of patients, APACHE Ⅱ score, CPIS score, etc., to compare its clinical features and significance; two groups of patients underwent bronchoscopy biopsy and bacterial culture quantitative analysis of each method of single and combined diagnosis of sensitivity and specificity. Results There were 23 cases in the infection group and 27 cases in the colonization group. There were significant differences (P <0.05) in the duration of mechanical ventilation, ICU stay, catheter indwelling time, disease composition and antibiotic use before emergence of drug- . Dynamic CPIS score showed that the infection group were higher than the colonization group, but only at 14 d intubation significant difference (P <0.05). Bronchial mucosal biopsy: the infection rate of inflammatory reaction was significantly higher than the colonization group (P <0.05). The number of inflammatory cells and neutrophils in the infected group were also significantly higher than those in the colonization group (P <0.05). Bacterial quantitative culture: the positive rate of infection in the infected group was significantly higher than that in the colonized group (P <0.05); the combined sensitivity of histopathology and quantitative culture And the highest specificity for the diagnosis of respiratory and lower respiratory tract infection the best method of accuracy. Conclusions Bronchial mucosa biopsy combined with bacterial quantitative culture has a high diagnostic value in identifying drug-resistant colonization bacteria or infectious bacteria, and clinical feasibility needs to be further confirmed on a large scale. Shorten the time of mechanical ventilation, ICU hospital stay and catheter indwelling time, will help reduce the occurrence of colonization bacteria.