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目的评价与常规吸痰管方法相比,CT导引下支气管镜获取痰标本进行细菌培养对重症肺炎患者的临床有效性和安全性。方法选取该院ICU确诊重症肺炎的成年患者87例作为研究对象,随机分为常规吸痰管留取标本组(A组)45例和CT导引下支气管镜留取痰标本组(B组)42例。记录患者年龄,性别,开始试验时、治疗后48h、5d、7d的APACHEⅡ评分、肺感染评分、白细胞计数,机械通气时间,ICU住院时间,28d病死率,抗生素相关治疗费用和总治疗费用。结果二组性别、年龄差异无统计学意义(P>0.05)。开始治疗时、治疗后48h,二组APACHEⅡ评分和肺感染评分差异无统计学意义(P>0.05),但治疗后5d和7d时B组APACHEⅡ评分和肺感染评分明显低于A组(P<0.05)。开始治疗时,二组白细胞计数差异无统计学意义,但治疗后48h、5d和7d时,B组白细胞计数明显低于A组(P<0.05)。B组机械通气时间和ICU住院时间明显短于A组,抗生素相关治疗费用和总治疗费用比较明显低于A组(P<0.05)。二组患者28d病死率比较差异无统计学意义。CT导引下支气管镜获取痰标本操作无任何并发症的发生。结论 CT导引下支气管镜获取痰标本方法对重症肺炎患者安全有效,值得临床推广。
Objective To evaluate the clinical efficacy and safety of sputum specimens obtained by bronchoscopy for bacterial culture in patients with severe pneumonia compared with conventional suction tube method. Methods Eighty-seven adult patients diagnosed as severe pneumonia in the hospital were enrolled in this study. They were randomly divided into routine suction sputum tube specimens (group A) 45 cases and CT guided bronchoscopy sputum specimens group B (group B) 42 cases. APACHEⅡscore, lung infection score, white blood cell count, hospital stay, ICU stay, mortality at 28d, antibiotic-related treatment costs and total treatment costs were recorded at the beginning of the experiment, 48h, 5d and 7d after treatment. Results There were no significant differences in gender and age between the two groups (P> 0.05). At the beginning of treatment, there was no significant difference in APACHEⅡscore and lung infection score between the two groups 48h after treatment (P> 0.05). However, APACHEⅡscore and lung infection score of group B at 5d and 7d after treatment were significantly lower than those of group A (P < 0.05). At the beginning of treatment, there was no significant difference between the two groups in the number of white blood cells, but at 48, 5 and 7 days after treatment, the white blood cell counts in group B were significantly lower than those in group A (P <0.05). The duration of mechanical ventilation and ICU stay in group B was significantly shorter than that in group A, and the costs of antibiotic-related treatment and total treatment were significantly lower than those in group A (P <0.05). There was no significant difference in the 28-day mortality rate between the two groups. CT-guided bronchoscopy to obtain sputum specimens without any complications. Conclusion CT-guided bronchoscopy to obtain sputum specimens for patients with severe pneumonia safe and effective, worthy of clinical promotion.