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目的 评价病原学定量培养 (QC)和常规定性培养 (RC)诊断方法对呼吸机相关肺炎(VAP)治疗结果的影响。方法 前瞻性对照研究了 31例机械通气患者连续发生的 93次VAP发病 ;VAP发病随机、交叉分为定量培养组和定性培养组 ,前者行纤维支气管镜引导保护性标本刷 (FOB PSB)取材及QC ,后者行气管内抽吸物常规定性培养 (ETA RC) ;经验性抗生素治疗由经治医生决定 ,根据培养及药敏结果调整治疗 ;对VAP的治疗结果加以评价。结果 应用定量培养和定性培养作为VAP的诊断手段 ,并采取基于两种诊断方式的随机抗生素治疗 ,VAP的治疗结果如病死率、二重感染发生率、耐药率及抗生素费用等无明显差异 ;不适当的最初经验抗生素治疗较适当治疗导致了更高的病死率 (17 7% )。结论 VAP的治疗结果可能更取决于最初经验治疗的正确性 ,而较少取决于诊断取材的类型。
Objective To evaluate the effect of quantitative aeration (QC) and routine qualitative culture (RC) diagnostic methods on ventilator-associated pneumonia (VAP) treatment. Methods A prospective and controlled study of 93 consecutive VAPs was performed in 31 patients with mechanical ventilation. The incidence of VAP was randomly divided into quantitative culture group and qualitative culture group. The former underwent fibrobronchoscope-guided protective specimen brushing (FOB PSB) QC, the latter tracheal aspirate routine qualitative culture (ETA RC); empirical antibiotic treatment by the doctor’s decision, according to the culture and susceptibility results to adjust treatment; evaluation of the results of the treatment of VAP. Results Quantitative culture and qualitative culture were used as diagnostic tools for VAP. Randomized antibiotic therapy based on two diagnostic methods was adopted. There was no significant difference in the treatment outcome of VAP such as case fatality rate, double infection rate, drug resistance rate and antibiotic expense. Inappropriate initial experience More appropriate antibiotic therapy led to a higher case fatality rate (17 7%). Conclusions The outcome of VAP may depend more on the correctness of initial empirical treatment and less on the type of diagnostic draw.