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目的探讨机械通气危重儿气管导管细菌生物膜对提高病原菌检出率的作用。方法选择2013年入住新生儿科需要机械通气的新生儿,根据机械通气的时间将研究对象分为3组:≤72 h组、73~168 h组及>168 h组,以漩涡振荡器振荡气管导管末端,振荡液培养,与同时送检的深部痰培养结果进行统计学比较。结果在机械通气时间≤72 h组、73~168 h组中,漩涡振荡器振荡液与深部痰培养的阳性率高度一致,Kappa值分别为0.799、0.710,P值分别为0.000及0.000;在>168 h组中,二者中度一致,Kappa值为0.651,P值为0.001。两种方法分离的菌株以产ESBL酶肺炎克雷伯杆菌最多见,产ESBL酶大肠杆菌次之,两种方法间菌株的构成及耐药性差异无统计学意义。结论以漩涡振荡器法获取气管导管细菌生物膜不能提高机械通气患儿的病原学检测阳性率,对临床用药无明显指导意义。
Objective To investigate the effect of tracheal catheter bacterial biofilm on the detection of pathogenic bacteria in critically ill children with mechanical ventilation. Methods Neonates with mechanical ventilation were enrolled in neonatology in 2013. According to the time of mechanical ventilation, the subjects were divided into three groups: ≤72 h group, 73 ~ 168 h group and> 168 h group. Vortex tracheal tubes End, shaking liquid culture, and at the same time send the results of deep sputum culture for statistical comparison. Results The positive rates of shaking vortex and deep sputum culture in the group of mechanical ventilation for 72 h and 73 ~ 168 h were highly consistent with Kappa values of 0.799 and 0.710, respectively, with P values of 0.000 and 0.000, respectively. 168 h group, the two moderate agreement, Kappa value of 0.651, P value of 0.001. The strains isolated by two methods to produce ESBL enzyme Klebsiella pneumoniae the most common, producing ESBL enzyme Escherichia coli second, the two methods between the strains of the composition and drug resistance was no significant difference. Conclusion The vortex tube method to obtain tracheal tube bacterial biofilm can not improve the positive rate of aetiology in children with mechanical ventilation, and has no obvious guiding significance for clinical medication.