纤维支气管镜在重型肝炎并发肺部感染病原学诊断中的应用

目的 探讨经纤维支气管镜检查取支气管灌洗液培养在重型肝炎并发肺部感染病原学诊断中的应用价值。方法 将86例重型肝炎并发肺部感染患者随机分为两组，A组42例经纤维支气管镜进行支气管灌洗液培养作病原学诊断，B组46例行痰培养作病原学诊断。根据药敏结果进行抗感染治疗。结果 A组42例患者中有1例不能耐受纤维支气管镜检查致采样失败。病原菌以革兰氏阴性菌为主；B组病原菌以革兰氏阳性菌和真菌为主。两种不同采样方法检测病原菌构成比有显著性差异（P=0．008）。根据药敏结果进行抗感染治疗后肺部感染治疗疗效，A组治疗显效和有效率为64．3％，B组显效和有效率仅为34．8％，两组肺部感染治疗效果有显著性差异（P=0．021）。A组42例患者中有24例（57．1％）死亡；B组46例患者中36例（78．3％）死亡，病死率有显著性差异（P=0．03）。结论 经纤维支气管镜行支气管灌洗液培养致病菌适用于重型肝炎并发肺部感染患者，准确率高，有助于肺部感染致病菌的正确判断及抗生素的合理选择。

The application of fiberoptic bronchoscopy in etiologic diagnosis of severe hepatitis patients with pulmonary infection

Objective To evaluate the role of bronchoalveolar lavage(BLAF)culture using fiberoptic bronchoscopy techniques in the etiologic diagnosis of severe hepatitis patients with pulmonary infections. Methods 86 severe hepatitis patients with pulmonary infections were at random divided into two groups. Patients in group A underwent fiberoptic bronchoscopy examination to obtain BLAF, and patients in group B were made etiologic diagnosis by sputum culture. Both groups were treated using antibiotics according to drug sensitivity results. Results One patient in group A could not bear fiberoptic bronchoscopy examination. Most pathogen in group A was Gram-negative bacterial infection, while in group B was Gram-positive bacterial and fungus infection. The proportions of etiology in group A and group B were different significantly (P=0.008).The effects of treatment according to drug sensitivity results in group A and group B were different significantly (P=0.021).The excellent effective rate and total effective rate were 64.3% in group A and 34.8% in B, respectively. There were 24 patients died in group A, and 36 patients died in group B, respectively. The mortalities of group A and group B were different significantly (P=0.03). Conclusion BALF culture using fiberoptic bronchoscopy was suitable for etiologic diagnosis in severe hepatitis patients with pulmonary infections. It was helpful in correct judgement and reasonable choice of antibiotics because of high accuracy.