Kingston G W, Phang P T, Leathley M J
Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Am J Surg. 1991 May;161(5):589-92. doi: 10.1016/0002-9610(91)90906-t.
Nosocomial pneumonia is frequent and is associated with high mortality in intubated mechanically ventilated patients. To determine whether there is a significant relationship between subclinical aspiration from nasogastric feeding and development of nosocomial pneumonia, we studied 24 ventilated patients who received nasogastric feeding. Endotracheal aspirates were tested twice daily for the presence of glucose using a glucose oxidase reagent strip. Subclinical aspiration was defined by the presence of glucose in nonbloody endotracheal aspirates. Nosocomial pneumonia was defined by the presence of all of the following conditions: (1) new or worsening infiltrate on chest roentgenogram consistent with pneumonia, (2) temperature greater than 38 degrees C and/or white blood cell count greater than 10,000/mm3 with 10% or more band forms, (3) culture of a new organism in the sputum, and (4) purulent tracheobronchial secretions. Twelve patients had no positive glucose tests of their endotracheal aspirates during their intensive care unit stay, one of whom developed nosocomial pneumonia. Twelve patients had endotracheal aspirates that were positive for glucose on 1 to 5 occasions. Of these patients, seven had bloody glucose-positive aspirates, four of whom developed clinical pneumonia. The remaining five patients had nonbloody glucose-positive endotracheal aspirates and all developed nosocomial pneumonia. There was a significantly greater incidence of pneumonia among patients who had nonbloody glucose-positive aspirates than among patients without glucose-positive aspirates (p less than 0.001, Fisher's exact test). We conclude that subclinical aspiration of nasogastric feeding, as detected by nonbloody glucose-positive endotracheal aspiration, is associated with the development of nosocomial pneumonia.
医院获得性肺炎很常见，且与机械通气插管患者的高死亡率相关。为了确定鼻饲引起的亚临床误吸与医院获得性肺炎的发生之间是否存在显著关联，我们研究了24例接受鼻饲的机械通气患者。使用葡萄糖氧化酶试纸条每天对气管内吸出物检测两次葡萄糖。非血性气管内吸出物中存在葡萄糖定义为亚临床误吸。医院获得性肺炎定义为存在以下所有情况：（1）胸部X线片上新发或加重的浸润影符合肺炎表现；（2）体温高于38摄氏度和/或白细胞计数高于10,000/mm³且杆状核细胞比例达10%或更多；（3）痰液中培养出新的病原体；（4）脓性气管支气管分泌物。12例患者在重症监护病房住院期间气管内吸出物葡萄糖检测均为阴性，其中1例发生了医院获得性肺炎。12例患者气管内吸出物葡萄糖检测有1至5次呈阳性。在这些患者中，7例吸出物葡萄糖阳性且伴有血性，其中4例发生了临床肺炎。其余5例患者非血性气管内吸出物葡萄糖阳性，均发生了医院获得性肺炎。非血性气管内吸出物葡萄糖阳性的患者中肺炎发生率显著高于无葡萄糖阳性吸出物的患者（p<0.001，Fisher精确检验）。我们得出结论，通过非血性气管内吸出物葡萄糖阳性检测到的鼻饲亚临床误吸与医院获得性肺炎的发生有关。
