论文部分内容阅读
目的:通过早期监测支气管肺泡灌洗液中感染细胞水平,探讨其在呼吸机相关性肺炎(VAP)早期诊断中的价值。方法:2011年1月至2013年12月,我们采用前瞻性研究方法对我院ICU接受机械通气超过48 h、临床诊断为VAP的成人患者进行研究观察,临床诊断当日行支气管肺泡灌洗,支气管肺泡灌洗液涂片经迈格吉染色(MGG),计数100个吞噬细胞内有病原微生物的感染细胞百分比(PIC);监测患者血降钙素原(PCT)质量浓度。将监测结果与最后确诊病例进行统计学分析。结果:有67例患者被纳入该研究,根据诊断标准,最终确诊52例,未确诊15例。确诊组在临床诊断当日血PCT质量浓度为(3.39±1.37)ng·ml-1,PIC水平为(3.20±1.56)%,均显著高于未确诊组,差异有统计学意义(P<0.05)。经过抗菌治疗3 d后,确诊组PCT质量浓度、PIC水平与未确诊组比较,差异均无统计学意义(P>0.05)。PIC诊断VAP的敏感度和特异度分别为76.9%和86.7%,PCT诊断VAP的敏感度和特异度分别为75.0%和73.3%,两种方法共同诊断VAP的敏感度和特异度分别为96.2%和96.2%。结论:PIC可作为VAP早期诊断的参考指标,与PCT联合应用可有效提高VAP的早期确诊率。
OBJECTIVE: To evaluate the value of early detection of ventilator-associated pneumonia (VAP) in early detection of infected cells in bronchoalveolar lavage fluid by early monitoring. Methods: From January 2011 to December 2013, we prospectively studied the ICU of our hospital who received mechanical ventilation for more than 48 hours and were clinically diagnosed as VAP. The clinical diagnosis of bronchial alveolar lavage, bronchial tube Bronchoalveolar lavage fluid was smear by Meggie (MGG) and the percentage of infected cells with pathogenic microorganisms in 100 phagocytic cells (PIC) was counted. The concentration of plasma procalcitonin (PCT) was monitored. The monitoring results and the final diagnosis of cases for statistical analysis. RESULTS: Sixty-seven patients were enrolled in the study. Based on the diagnostic criteria, 52 were finally diagnosed and 15 were not diagnosed. The serum PCT concentration in the diagnosis group was (3.39 ± 1.37) ng · ml-1 on the day of clinical diagnosis, and the level of PIC was (3.20 ± 1.56)%, which were significantly higher than those in the unconfirmed group (P <0.05) . After 3 days of antimicrobial treatment, there was no significant difference in PCT quality and PIC between the diagnosed group and the unconfirmed group (P> 0.05). The sensitivity and specificity of PIC in diagnosing VAP were 76.9% and 86.7% respectively. The sensitivity and specificity of VAP in diagnosing VAP were 75.0% and 73.3% respectively. The sensitivity and specificity of VAP in diagnosing VAP by the two methods were 96.2% And 96.2%. Conclusion: PIC can be used as a reference for the early diagnosis of VAP, and combined with PCT can effectively improve the early diagnosis of VAP.