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临床指标被认为不适于诊断呼吸相关性肺炎(VAP),部分作者声称VAP的诊断必须依据下呼吸道支气管镜采样标本的量化培养结果。进而形成了临床怀疑VAP但微生物学检查阴性者不能使用抗生素的观点。但VAP诊断评估的起点仍是临床指标,确定该标准的准确性自然是非常重要的。作者评估了各种临床标准的诊断价值以及微生物学检验对VAP诊断准确性的影响。 方法 25例机械通气>72小时并最终死亡的呼吸科加强监护病房患者均接受了抗生素治疗。抗生素平均使用时间为9.5天。死后0～90分钟内进行无创和有创性标本收集。先通过经支气管吸引(TBA),再用支气管镜进行双肺纤维支气管镜检查,并在胸片中炎性浸润最明显的区域进行保护刷(PSB)采样。之后进行尸检。每侧患者取得不同部位
Clinical criteria are not considered appropriate for the diagnosis of respiratory-related pneumonia (VAP), and some authors claim that the diagnosis of VAP must be based on quantification of bronchoscopic sampling of the lower respiratory tract. Which leads to the idea that antibiotics can not be used in clinically suspected VAP but negative in microbiology. However, the starting point for diagnostic evaluation of VAP is still clinical indicators. It is of course very important to determine the accuracy of this standard. The authors assessed the diagnostic value of various clinical criteria and the impact of microbiological tests on the diagnostic accuracy of VAP. Methods Twenty-five patients in the intensive care unit of the intensive care unit who had mechanical ventilation for> 72 hours and eventually died were treated with antibiotics. The average duration of antibiotics is 9.5 days. 0 to 90 minutes after death for noninvasive and invasive collection of specimens. Pulmonary bronchoscopy was first performed by bronchial aspiration (TBA) followed by bronchoscopy, and protective brush (PSB) sampling was performed in the area with the most infiltrated infiltrates in the chest. After the autopsy. Each side of the patient to obtain different parts