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目的 观察气管导管内表面细菌生物被膜 (BF)形成情况并初步探讨其在呼吸机相关性肺炎 (VAP)发生中的作用。方法 用扫描电子显微镜和透射电子显微镜分别观察拔出的气管导管内表面 ,同时作下呼吸道和导管内壁细菌学检测。结果 76 % (19/ 2 5 )气管导管内壁覆盖不定型基质物 ,其平均插管时间 [(10 7± 7 9)天 ],长于无不定型基质物覆盖的导管的插管时间 [(2 1± 0 8)天 ](P <0 0 5 ) ;78% (14/ 18)不定型基质物中含大量球菌或杆菌 ;导管内壁含致病菌的 16例中 ,11例在插管期间即从下呼吸道分泌物中分离得到相同菌株 ;在 7/ 8VAP患者中 ,VAP病原体与导管内分离的病原体相同。结论 气管导管内细菌BF形成与插管时间密切相关 ,导管内细菌BF的存在可能与VAP病原体有一定相关性。
Objective To observe the formation of bacterial biofilm (BF) on the inner surface of tracheal tube and to explore its role in the pathogenesis of ventilator-associated pneumonia (VAP). Methods The inner surface of the tracheal tube was observed by scanning electron microscopy and transmission electron microscopy, respectively, and the bacteriological examination of the lower respiratory tract and the inner wall of the catheter was also performed. Results 76% (19/25) of the endotracheal tubes covered the unstructured matrix with an average intubation time of (10 7 ± 7 9 days) longer than that of catheters covered with unconfined matrix [(2 1 ± 0 8) days] (P <0 05); 78% (14/18) of the amorphous matrix contained a large amount of coccus or bacilli; of the 16 cases with pathogenic bacteria in the inner wall of the catheter, 11 The same strain was isolated from the lower respiratory secretions; in 7/8 VAP patients, the same pathogen was isolated from the catheter as the VAP pathogen. Conclusion The formation of bacteria in the trachea is closely related to the time of intubation. The presence of bacteria in the duct may be related to the pathogens of VAP.