摘要
目的评价常规对气道分泌物进行定期细菌培养,提前获取病原学资料,用于指导呼吸机相关性肺炎(VAP)抗生素治疗的价值。方法对2007年3月至2010年3月接受机械通气时间超过48h的247例患者进行定期气道分泌物细菌培养,如果患者有潜在VAP则行经纤维支气管镜肺泡灌洗(BAL)进行诊断,并根据前一次定期培养结果指导抗生素使用,直至获得BAL培养结果。此后,再根据BAL培养结果调整抗生素治疗方案,并评价先前抗生素治疗的合理性。结果 247例患者中,经定期呼吸道分泌物细菌培养,54例患者被怀疑VAP,经BAL细菌培养,36例患者被诊断为VAP,其中早发型10例,迟发型26例。36例VAP中31例BAL细菌培养结果与前一次定期分泌物培养结果一致。在可评价的病例中,根据定期呼吸道分泌物细菌培养结果使用抗生素治疗,准确合理(91.4%,95%CI83%～100%)。11例疑似VAP患者避免了不必要的抗生素治疗。结论定期气道分泌物细菌培养结果能够及时准确地指导VAP的抗生素治疗。
Objective To appraise the value of periodical culture of airway secretions for obtaining the etiology information in advance to guide antibiotic treatment of ventilator-associated pneumonia （VAP）.Methods A total of 247 patients received the therapy of mechanical ventilation for more than 48 hours between March 2007 and March 2010 were included in this study.The airway secretions from endotracheal aspiring substance were cultured periodically from initiation of building artificial airway.If the patients had a potential sign of VAP,the samples of brochoalveolar lavage （BAL） were used for confirmed diagnosis of VAP.During the patients suffered from potential VAP,antibiotics were applied according to the previous result of regular culture till acquiring etiologic result of BAL.Then the scheme of antibiotic therapy was adjusted according to BAL results,and the appropriateness of initial antibiotic therapy was assessed.Results Of 247 patients,54 were diagnosed as suspicious VAP,and 36 cases of them were diagnosed as VAP including precocious type（n=10） and delayed type （n =26） via BAL culture.In 31 out of 36 VAP cases,there were identical results on BAL and the previous regular culture.The antibiotic therapies according to the regular culture result were accurate and rational（91.4%,95% CI 83% ～ 100%） in assessable cases,and 11 patients with suspected VAP avoided unnecessary antibiotic treatment.Conclusions The results of regular airway secretions culture can provide a timely and accurate guidance on the antibiotic therapy of VAP.
出处
《中国临床研究》
CAS
2011年第5期377-379,共3页
Chinese Journal of Clinical Research
关键词
呼吸机相关性肺炎
抗生素
呼吸道分泌物
细菌培养
支气管肺泡灌洗
Ventilator-associated pneumonia； Antibiotics； Airway secretions； Bacterial culture； Brochoalveolar lavage
