Castella J, Ausina V, Puzo C, Quintana E, Rodríguez-Froján G, Rello J, Lunquin M, García-Pachón E, Belda P, García-Barceló M
Servicio de Aparato Respiratorio, Hospital de la Santa Creu i Sant Pau, Barcelona.
Med Clin (Barc). 1991 May 18;96(19):721-6.
The identification of causative microoganisms in severe pneumonias is a usually difficult problem. Protected brushing (PB) has a good specificity but a limited sensitivity. Conventional bronchoalveolar lavage (BAL-C) has an excellent sensitivity but a doubtful specificity. The investigation of a new technique such as the protected bronchoalveolar lavage (BAL-P) appears as logical, as it should combine the advantages of PB and BAL-C without their drawbacks.
In 15 patients without bacterial or fungal infections and in 23 with bacterial or fungal pneumonia, quantitative cultures were carried out in the samples obtained with PB, BAL-P and BAL-C. PB and BAL-C were performed with the usual technique. BAL-P was performed through the internal catheter of a telescoped double catheter with reabsorbable distal cap within the fibroscope channel. 40 ml of saline were instillated for the lavage.
With BAL-P sensitivity was 95% and specificity 89%. These were, respectively, 55% and 94% with PB, and 95% and 42% with BAL-C. The technique of BAL-P was more complex an longer than that of PB.
If these results are confirmed in further studies, BAL-P might become a method of choice for the bacterial pneumonias where now PB is indicated. However, in patients with hypersecretion or when bronchoscopy should be rapidly carried out, PB is technically more feasible.
在重症肺炎中确定致病微生物通常是个难题。保护性毛刷采样（PB）具有良好的特异性，但敏感性有限。传统支气管肺泡灌洗（BAL-C）具有出色的敏感性，但特异性存疑。研究一种新技术，如保护性支气管肺泡灌洗（BAL-P）似乎是合理的，因为它应能结合PB和BAL-C的优点而无其缺点。
对15例无细菌或真菌感染的患者以及23例有细菌或真菌性肺炎的患者，对用PB、BAL-P和BAL-C获取的样本进行定量培养。PB和BAL-C采用常规技术进行。BAL-P通过纤维支气管镜通道内带可吸收远端帽的伸缩双导管的内导管进行。注入40 ml生理盐水进行灌洗。
BAL-P的敏感性为95%，特异性为89%。PB的敏感性和特异性分别为55%和94%，BAL-C的敏感性和特异性分别为95%和42%。BAL-P技术比PB更复杂，耗时更长。
如果这些结果在进一步研究中得到证实，BAL-P可能会成为目前推荐使用PB的细菌性肺炎的首选方法。然而，在分泌物过多的患者或需要快速进行支气管镜检查的患者中，PB在技术上更可行。
