痰涂片革兰染色对重症监护室医院获得性肺炎早期诊治的意义

Value of sputum smear gram staining in the early diagnosis and treatment of hospitalacquired pneumonia in intensive care unit patients

摘要:

目的评价痰涂片革兰染色在重症监护室（ICU）医院获得性肺炎（HAP）患者中早期临床诊断及指导用药的意义和价值。方法对某院ICU 2011年3月—2012年2月疑诊医院获得性肺炎的289例患者，经人工气道抽取下呼吸道痰标本，分别进行痰涂片革兰染色镜检和病原学培养，对培养出来的病原菌进行菌种鉴定，比较两种方法的检验结果。结果送检痰标本890份，其中合格标本790份，合格率为88.76%。共培养出病原菌520株（65.82%），其中革兰阴性（G-）菌330株，革兰阳性（G+）菌130株，真菌60株。痰涂片革兰染色镜检与病原菌培养结果比较，两者符合率为72.15%（570/790），两种方法检测结果差异无统计学意义（χ2=1.818,P=0.2000）；痰涂片革兰染色镜检诊断敏感性为80.77%（420/520），特异性为55.56%（150/270），阳性预测值为77.78%（420/540），阴性预测值为60.00%（150/250）。结论合格的下呼吸道痰标本革兰染色镜检能够协助HAP 的早期诊断与治疗。

Abstract:

ObjectiveTo evaluate the significance of sputum smear gram staining in the early diagnosis and guidance for antimicrobial treatment of hospitalacquired pneumonia (HAP) in intensive care unit patients.MethodsFrom March 2011 to February 2012, sputum samples taken from lower respiratory tract of 289 patients with  suspected HAP were performed gram staining and culture, the isolated pathogens were identified, results of two methods were compared.ResultsA total of 890 sputum specimens were sent for detection , 790(88.76%)  specimens were qualified. A total of 520(65.82%) pathogenic strains were isolated , 330 isolates were gramnegative bacteria, 130 were grampositive bacteria, and 60 were fungi. The concordance between the results of two methods was 72.15%（570/790）, there was no significant difference between two methods(χ2=1.818,P=0.2000). The sensitivity and specificity of sputum smear gram staining was 80.77% （420/520）and 55.56% （150/270）respectively, the positive predictive value and negative predictive value was 77.78% （420/540）and 60.00% （150/250）respectively.ConclusionGram staining of the qualified sputum samples of lower respiratory tract is helpful in early diagnosis and treatment of HAP.