摘要目的 评价盲法远端插入双腔导管采样(PTC)与支气管镜下保护性毛刷(PSB)对呼吸机相关性肺炎(VAP)病原学诊断的价值.方法 收集2008年1月至2009年2月青岛大学医学院第二附属医院内科ICU住院的69例怀疑VAP的机械通气患者,入选标准为首次住院时间超过48 h、接受过机械通气治疗并怀疑VAP的患者,均进行PSB和PTC检查,所有检杳结果均按照≥10~6 CFU/L标准进行阳性评判,若标本中出现草绿色链球菌、淡黄色奈瑟球菌则考虑标本污染而剔除.结果 所取标本先经革兰染色涂片光镜下判定,69例中PTC和PSB方法检查结果的阳性例数分别60例(87.O%)和58例(84.1%).所有标本均进行细菌培养,以PSB为金标准,PTC的敏感度为82.1%,特异度为92.7%,阳性预测值为88.5%,阴性预测值为88.4%.结论 对于近期进行机械通气的患者,如果怀疑VAP但没有条件进行PSB或支气管肺泡灌洗时,PTC是一种有价值的检测方法.

abstractsObjective To compare the diagnostic value of blind double-lumen plugged telescoping catheter( PTC) and protected specimen brush(PSB) in patients requiring mechanical ventilation ( MV) for suspected ventilation-associated pneunonia( VAP). Methods Sixty-nine patients with a hospital stay of ≥ 48 h who required MV for suspicion of VAP were prospectively enrolled in the study during Jan 2008 and Feb 2009 in the medical intensive care unit. The patients all underwent bronchial samplings: a blind PTC and a fiberoptic PSB were performed successively in each case. A positive culture for both sampling procedures was defined as the recovery of ≥ 10~6 CFU/L of at least one potential pathogen. Results The overall specimen were judged by film preparation through the microscopic examination. The positive result of PTC and PSB were 60(87. 0% )and 58 (84. 1% ) respectively. Bacterial culture was performed for all the specimen and PSB was regarded the golden standard. PTC had a sensitivity of 82. 1 % , a specificity of 92. 7% , a positive predictive value of 88. 5% , and a negative predictive value of 88. 4%. Conclusion PTC may be a reliable alternative to the newly mechanically ventilated patients with suspicion of VAP.