重症肺炎患者机械通气排气管路细菌学特征分析

目的:研究重症细菌性肺炎机械通气患者下呼吸道分泌物、呼吸机呼气管道冷凝水和呼吸机排出气的细菌学特征。方法:对74例重症细菌性肺炎患者在机械通气治疗24h时分别采集下呼吸道分泌物、呼吸机排气管冷凝水、呼吸机排出气的标本,进行半定量细菌培养。结果:74例下呼吸道分泌物中细菌培养阳性64例;呼气管冷凝水细菌培养阳性51例,与其下呼吸道分泌物培养结果的符合率为96.08%(49/51);呼吸机排气口气体细菌培养阳性35例,与下呼吸道分泌物培养结果的符合率为91.43%(32/35),与冷凝水培养结果的符合率为97.14%(34/35)。结论:重症肺炎应适当缩短呼吸机管道更换间隔(24h);致病菌由呼吸道→呼吸机管路→呼吸机排出气的传播路径不容忽视;机械通气患者呼气管冷凝水细菌培养结果对呼吸道病原学诊断具有借鉴意义。

Analysis of Bacteriology Character of the Ventilator Exhaust Line in Severe Pneumonia Patients

Objective: To investigate the bacteriological characters among secretion of lower respiratory tract,condensed water in exhaust hose and exhaust gas of severe pneumonia patients using ventilator. Methods: The results of seventy-four ventilator used for severe pneumonia patients were included in this study. Specimens of secretion of lower respiratory tract,condensed water in exhaust hose and exhaust gas were collected at 24 hours after mechanical ventilation,and demi-quantitate bacterial culture were performed. Results: The bacteriological positive results of secretion of lower respiratory tract,condensed water in exhaust hose and exhaust gas was 64,51 and 35 respectively. The coincidence between condensed water and secretion of lower respiratory tract was 96.08%(49/51). The results of exhaust gas coincide to secretion of lower respiratory tract and condensed water were 91.43%(32/35)and 97.14%(34/35) respectively. Conclusion: The interval time of changing ventilator tube can be appropriately decurtated for severe pneumonia patients. The respiratory tract-exhaust hose-exhaust gas disseminated route should not be neglected. The bacteriological results of condensed water in exhaust hose provide new ideas to etiologic diagnosis for ventilated patients.