22例下呼吸道感染细菌学及药物敏感试验分析

目的 比较两种呼吸道病原体的取材形成，对呼吸道致病菌的阻性率，细菌学及药物敏感性进行比较。方法 收集下呼吸道感染住院病人咳痰及经纤维支气管镜防污染毛刷（ＰＳＢ）深部取痰进行病原体培养及药敏试验。结果 咳痰检阳性率４１％，深部取材培养阳性率７３％，两者符合率２５％，有显著性差异性；经纤维支气管镜防污染毛刷２显示，致病菌以革兰氏阴性杆菌为主达７７％，其中假单胞菌属占３３％，革兰氏阴性杆菌中对代头孢，氟     

经纤支镜肺泡灌洗治疗难治性下呼吸道感染临床分析

目的探讨纤维支气管镜支气管肺泡灌洗术在难治性下呼吸道感染的治疗价值。方法 60例难治性下呼吸道感染患者进行纤维支气管镜支气管肺泡灌洗（BAL）检查,灌洗液送细菌培养,根据细菌培养结果,针对细菌敏感性药物对症治疗。结果 60例难治性下呼吸道感染患者BAL治疗均取得良好疗效。结论纤维支气管镜支气管-肺泡灌洗检查,对于难治性下呼吸道感染患者,是一种相对安全而有效的治疗方法。     

纤维支气管镜对下呼吸道异物的诊治

目的探讨经纤维支气管镜(纤支镜)对下呼吸道异物的诊断和钳取的方法和效果。方法在常规纤支镜检查确定为异物后使用异物钳分别对8例患者下呼吸道的异物进行钳取。结果找到下呼吸道不同异物者经纤支镜钳取均获得成功,无1例出现并发症。结论纤支镜可作为对下呼吸道异物诊断和钳取的重要工具。     

纤维支气管镜对下呼吸道异物的诊治

目的：探讨经纤维支气管镜（纤支镜）对下呼吸道异物的诊断和钳取的方法和效果。方法在常规纤支匀检查确定为异物钳分别对8例患者下呼吸道的异物进行钳取,结果找到下呼吸道不同异物者经纤支镜钳取均获得成功,无1例出现并发症。结论纤支镜可作为对下呼吸道异物诊断和钳取的重要工具。     

多重PCR检测支气管肺泡灌洗液中细菌性病原体的研究

目的评价呼吸道感染患者肺泡灌洗标本进行多重PCR检测的准确性。方法选取2006～2009年本院住院的158例儿童为研究对象,同时选用需要接受纤维支气管镜检查的30例同龄非感染患儿作为对照。所有儿童24h内接受标准的纤维支气管镜介导的支气管肺泡灌洗。用多重PCR检测灌洗液中肺炎链球菌、流感嗜血杆菌、肺炎支原体和肺炎嗜衣原体。并用细菌培养等常规方法对这些患者的肺泡灌洗液进行分析。结果常规细菌学诊断方法显示,肺炎链球菌,流感嗜血杆菌,肺炎支原体,肺炎嗜衣原体在下呼吸道感染病人中分别占14％,21％,3．2％,和0％。而应用肺泡灌洗液多重PCR这种诊断方法,这些病原体在这些病人中分别占了28％,47％,4％和1％,其敏感性分别为87％。90％,100％和0％,特异性分别为81％,64％,100％和99％。在104位检查前服用了抗生素的支气管镜检患者中,肺炎链球菌通过细菌培养来确诊占2．9％,而通过多重PCR则为31％。在对照组中多重PCR鉴别肺炎链球菌的比例为17％．流感嗜血杆菌为40％。结论在下呼吸道感染病人中,支气管肺泡灌洗液结合多重PCR能够有效的用来鉴别肺炎链球菌,流感嗜血杆菌,肺炎支原体,肺炎嗜衣原体,这在已经用抗生素治疗的病人中尤为有效。     

纤支镜检查在痰菌阴性肺结核诊断的临床应用

目的:探讨纤维支气管镜(纤支镜)对痰菌阴性肺结核确定诊断的临床应用价值。探讨纤支镜下联合取材对涂片阴性肺结核的诊断价值。方法:采用回顾性分析法,对289例确诊为肺结核的纤支镜检查结果进行统计学分析,使用olympusBF-P20纤支镜检查及毛刷涂片及组织学检查。了解刷检、灌洗、钳检和术后痰涂片检查4种不同取材方法对肺结核诊断的阳性率。结果:刷检涂片、灌洗液抗酸菌涂片、钳检和术后痰涂片检查分别占纤支镜确诊总例数的19.4%(56/289)、53.3%(154/289)、11.8%(34/289)和15.6%(25/289)。结论:纤支镜检查对肺结核的确诊具有重要的临床应用价值。纤支镜下联合取材可提高涂片阴性肺结核的诊断率。     

纤维支气管镜对成年患者下呼吸道异物的临床诊治

目的探讨纤支镜诊治成年患者下呼吸道异物的临床价值。方法回顾分析我院2001年4月~2011年4月间140例成年患者下呼吸道异物病例的相关资料,其中80例采用纤支镜手术,60例采用支气管镜手术。结果本组纤支镜一次性治愈率明显高于支气管镜一次性治愈率,异物多位于右支气管。均成功钳取异物,122例异物位于右支气管,18例位于左支气管。术中79例直接窥见异物并直接取出;61例表面覆盖分泌物,其中21例肉芽组织增生明显,仅51例一次性取出。均无严重并发症。结论纤支镜是诊治成年患者下呼吸道异物的有效方法。     

阴道加德菌与阴道炎关系的探讨

对84例阴道炎患者和153例非阴道炎妇女的阴道分泌物,进行了pH测定,涂片革兰染色镜检;用改良兔血琼脂平板进行了阴道加德菌(GV)和其他细菌的分离培养,结合临床学调查和妇科检查,探讨GV与阴道炎的关系.阴道炎组和非阴道炎组的GV分离率有非常显著的差异(P<0.01)。细菌性阴道病(BV)组与非BV组的GV分离率更有非常显著的差异(28.12％对2.44％,P<0.001).研究表明,非培养法的BV实验室诊断,尤其是标本涂片检出大量革兰阴性杆菌和线索细胞(Clue cell)对BV的诊断有重要价值.     

利多卡因雾化吸入复合全麻在无痛纤支镜检查中的应用

目的观察利多卡因雾化吸入复合全身麻醉下行无痛纤支镜检查和治疗的麻醉效果及安全性。方法 48例行无痛纤维支气管镜检查和治疗的病人,随机分为雾化吸入表面麻醉＋全麻组（观察组）和喷雾表面麻醉＋全麻组（对照组）,观察组术前使用2%利多卡因超声雾化吸入,对照组术前使用2%利多卡因上呼吸道喷雾,两组患者检查时均复合丙泊酚及芬太尼静脉注射全身麻醉。观察术中呛咳情况,脉搏血氧饱和度、血压、心率等的变化,记录检查中丙泊酚用量,纤支镜操作者对麻醉效果的满意度评分。结果观察组纤支镜检查时剧烈呛咳病例数、脉搏血氧饱和度降低、血压及心率升高低于对照组（P≤0.05）,丙泊酚用量低于对照组（P≤0.05）,纤支镜操作者对麻醉效果满意度评分高于对照组（P≤0.05）,差异有统计学意义。结论在无痛性纤维支气管镜检查治疗前,雾化吸入利多卡因表面麻醉,配合全身麻醉,可更好地维持检查过程中心血管系统和血氧饱和度相对稳定、减少静脉麻醉药用量,提高纤支镜操作者的满意度,临床应用安全有效。     

痰液半定量培养与下呼吸道铜绿假单胞菌感染的关系

目的探讨痰标本细菌半定量培养12级法与下呼吸道铜绿假单胞菌感染诊断的关系。方法涂片观察标本质量、白细胞吞噬菌及白细胞浓集区域优势菌,同时采用细菌半定量12级法培养。查阅分离出铜绿假单胞菌的患者病历,统计分析首次培养的细菌数量与出院诊断的关系。结果白细胞吞噬细菌现象的确存在,但不多见。铜绿假单胞菌128株,其首次培养的相对数量0.1、0.2、≥0.3的确诊率分别为76.9%、78.3%、76.1%;三者的确诊、疑诊、否诊比较,Х^2=-52.096,P〉0.995。首次培养标本质量为A、B、C级的确诊率分别为91.7%、79.4%、63.4%;A＋B级与C级1次的确诊率比较,Х^2=4.82,P〈0.05;C级1次与C级2次（第1次为C级,第2次未必）的确诊率比较,Х^2=0.014,P〉0.9。结论按规定要求采集痰标本,若其半定量12级法培养出涂片拟分离菌对应性铜绿假单胞菌的相对数量〉该菌口咽部平均携带数量时,应作药敏试验。     

支气管镜在急性气道堵塞性疾病中的应用及疗效观察

目的探讨支气管镜对急性气道堵塞的治疗作用。方法对279例气道堵塞病人行急诊支气管镜检查治疗，并观察其效果。结果经气管镜及时诊断并清除气道内堵塞物后，患者症状迅速改善，总有效率98．9％。结论支气管镜能及时发现及解除气道堵塞，纠正急性呼吸衰竭，通过支气管镜局部用药有利于控制肺部感染，提高抢救成功率。     

纤维支气管镜检查对不典型肺结核的诊断价值

本文报告46例痰菌阳性,胸片和(或)临床表现不典型,临床误诊为原发性和转移性肺癌、肺炎、肺不张及肺脓肿等的不典型肺结核的纤维支气管镜(纤支镜)检查结果。44例(95.7％)确诊为肺结核。其中42例刷检涂片,39例(92.9％)查到抗酸杆菌;39例活检,17例(47.7％)病理诊断为结核病。结果表明,纤支镜检查对不典型肺结核的诊断有肯定的价值。     

Streptococcal pharyngitis--rapid diagnosis by Gram stain.

Group A beta-haemolytic streptococci were isolated from 51 (9.8%) of 519 patients with pharyngitis. Throat culture results showed the mean sensitivity, specificity and predictive value of a positive Gram-stained smear of pharyngeal secretions as 70%, 89% and 69%. The data suggest that Gram staining of a smear directly from the swab is as accurate as and more speedy than a culture from the pharyngeal secretion for diagnosis of streptococcal pharyngitis.     

The role of diagnostic fiberoptic bronchoscopy for rapid diagnosis of pulmonary tuberculosis.

The role of fiberoptic bronchoscopy for rapid diagnosis of pulmonary tuberculosis was examined among 74 patients who were suspected of having the disease but had negative sputum smear for acid fast bacilli. Bronchial brushing and washing were routinely performed in all subjects and bronchial biopsy was performed on abnormal mucosa in 7 of them. The diagnosis of pulmonary tuberculosis was confirmed in 44.6% of the patients studied from smear examination, culture, histology or the combination of them. Rapid diagnosis was achieved in 54.5% of the confirmed cases from smear or histology within a few days of examination. Two of the cases had concomitant bronchogenic carcinoma. We conclude that the fiberoptic bronchoscopy is a useful investigation for this group of patients as confirmation of the diagnosis can be made fairly rapidly in a significant proportion of them, hence the treatment can be started confidently.     

Drug-resistance analysis of Gram-negative bacilli producing extended-spectrum beta-lactamases in lower respiratory tract infection]

OBJECTIVE: To analyze occurrence of Gram-negative bacteria producing extended-spectrum beta-lactamase (ESBL) in patients with lower respiratory tract infection and assess their drug sensitivity to provide evidence for clinical management of lower respiratory tract infection with drug-resistant ESBL-producing bacteria. METHODS: A total of 312 Gram-negative bacterial strains were isolated from patients with lower respiratory tract infection and identified for the presence of ESBL by Vitek ESBL detection test and double-disk synergy tests as well as standard disk diffusion test. The effects of 10 antibacterial drugs on ESBL-producing strains were compared. RESULTS: A rate of 20.1% of the isolated strains were identified to produce ESBLs, including Klebsiella Pneumoniae, Escherichia coli, Enterobacter cloacae, Pseudomonas aeruginasa and Klebsiella oxytocla (accounting for 30.1%, 29.1%, 27.0%, 11.3%, and 2.5%, respectively, of the ESBL-producing strains). Imipenem possessed the most powerful antibacterial activity against ESBL-producing strains. CONCLUSIONS: Attention should be given to lower respiratory tract infections with ESBL-producing Gram-negative bacilli, and imipenem can be the primary choice for fighting such infections.     

难治性肺炎支原体肺炎急性期治疗对肺炎后呼吸道事件的影响

目的探讨儿童难治性肺炎支原体肺炎(RMPP)急性期的治疗方式是否影响肺炎后慢性咳嗽、反复呼吸道感染的发生。方法对63例3～14岁RMPP患儿进行回顾性分析,治疗方式分为是否静脉用红霉素、是否全身用肾上腺皮质激素(激素)、是否纤维支气管镜(简称纤支镜)镜下冲洗、是否静脉用丙种球蛋白(丙球),肺炎后(指病程6周后)呼吸道事件分为慢性咳嗽、反复呼吸道感染,进行多因素Logistic回归分析。结果多因素Logistic回归分析显示,RMPP急性期全身用激素与肺炎后慢性咳嗽(回归系数=-1.869,P=0.003)、反复呼吸道感染(回归系数=-1.359,P=0.040)的发生呈负相关,急性期进行纤支镜镜下冲洗与肺炎后慢性咳嗽(回归系数=-1.734,P=0.016)的发生负相关,结果有统计学显著意义。结论儿童RMPP急性期全身用激素、进行纤支镜镜下冲洗可以减少肺炎后慢性咳嗽的发生,全身用激素可以减少肺炎后反复呼吸道感染的发生。     

A prospective hospital study of the aetiology of community-acquired pneumonia

In a one-year prospective study of 106 adults (mean age, 60 years) who were admitted to hospital with community-acquired pneumonia, an aetiological diagnosis was made in 82 (77%) patients. Streptococcus pneumoniae was considered to be responsible for 44 (42%) and respiratory viruses for 19 (18%) infections. Other aetiological agents that were found in a smaller number of patients included Haemophilus influenzae (9% of patients), enteric Gram-negative bacilli (8% of patients), Staphylococcus aureus (3% of patients), Legionella spp. (3% of patients), Mycobacterium tuberculosis (3% of patients), Mycoplasma pneumoniae (8% of patients) and Chlamydia psittaci (5% of patients). The mortality was 10% and was related significantly to increasing age and to coexisting heart and lung disease. Antibiotic treatment that was commenced before admission to hospital and investigations were undertaken reduced significantly the isolation rate of susceptible bacterial pathogens. The Gram-stained smear of sputum was valuable in establishing a tentative diagnosis of bacterial pneumonia. The most-useful tests in making an early diagnosis proved to be those which detected pneumococcal and mycoplasmal antigens, blood cultures and culture of sputum for appropriate bacterial pathogens.     

下呼吸道感染病原菌及耐药性的探讨

目的探讨下呼吸道感染的病原菌及耐药性特点。方法对274例下呼吸道感染患者的下呼吸道分泌物进行细菌培养和药敏试验。结果痰标本中检出病原菌239株,最主要为鲍曼不动杆菌和铜绿假单胞菌;其中革兰阳性杆菌和革兰阴性杆菌都显示出了较高的耐药性。结论下呼吸道感染的病原菌的耐药情况较为普遍,应合理使用有效的抗菌药物。     

防污染样本毛刷采样用于肺部细菌感染的病原学诊断

采用防污染样本毛刷(PSB),经纤维支气管镜对50例肺炎及30例无呼吸系感染者(对照组)从下呼吸道刷取分泌物做细菌培养。同时采用日产单导管采样毛刷(SSC)采样及取口痰培养以资对比。50例PSB采样中38例细菌培养阳性,其中致病菌36例,阳性率为72％。而30例对照组仅2例致病菌阳性,两者有显著性差异(P<0.01)。观察组38例阳性病例中2例为非致病菌生长,提示PSB有较好的防污染性能。     

降钙素原与C反应蛋白联合检测在成人下呼吸道感染中的临床价值

目的评价检测降钙素原（PCT）与C反应蛋白（CRP）水平对成人下呼吸道感染诊断的临床意义。方法52例细菌感染下呼吸道感染患者血清PCT、CRP的含量及动态变化进行检测,按不同感染类型分类比较降钙素原水平的差异。结果细菌感染组（8．9±1．2）ng／mL,非细菌感染组（0．1±0．09）ng／mL,两组比较差异有统计学意义（P〈0．05）。细菌感染不同类型感染组降钙素原比较：脓毒症组、医院获得性感染组、慢性阻塞性肺疾病急性加重组与非细菌感染组比较,差异有统计学意义（P〈0．05）,其他下呼吸道感染组与非细菌组比较差异无统计学意义（P〉0．05）。对细菌培养阳性病例进行APACHE评分存在正相关性（r=0．58,P=0．02）。结论血清PCT、CRP联合检测在细菌感染的早期诊断中有一定价值．动态监测PCT水平有助于评估治疗效果。