Gong H, Soffer M J, Ertle A R, Inderlied C B, Bruckner D A
Department of Medicine, UCLA School of Medicine.
Diagn Microbiol Infect Dis. 1988 Oct;11(2):87-100. doi: 10.1016/0732-8893(88)90077-6.
The diagnostic yield and safety of a novel nasotracheal protected specimen brush (PSB) were evaluated in 15 nonintubated adult patients with suspected bacterial pneumonia. A double-catheter PSB was passed directly through the anesthetized nose and into the trachea without bronchoscopy or fluoroscopy. Endotracheal brushing was performed in less than 10 sec, and the brush was immediately processed for Gram staining and quantitative aerobic and anaerobic cultures. According to clinical follow-up and response to therapy, 11 episodes of bacterial pneumonia and five cases of nonbacterial lung disease were established. The PSB Gram stain confirmed lower respiratory sampling in all cases. The PSB cultures indicated respiratory pathogens in 9/11 (82%) cases of pneumonia, with greater than 10(3) colony-forming units (cfu)/ml in all but two specimens. All patients with pneumonia responded to specific antibiotics. All patients with nonbacterial disorders had PSB cultures of less than 10(3) CFU/ml, and their pulmonary processes improved without antibiotic therapy. The procedure was well tolerated, although two patients had transient bronchospasm or apnea. Experience with the nasotracheal PSB is limited, but the procedure appears to be a reliable and relatively safe alternative diagnostic method in selected patients with suspected bacterial pneumonia. Quantitative cultures are necessary to improve its diagnostic accuracy.
在15例疑似细菌性肺炎的非插管成年患者中评估了一种新型鼻气管保护性标本刷（PSB）的诊断率和安全性。一根双导管PSB在无需支气管镜检查或荧光透视的情况下直接经麻醉的鼻腔插入气管。气管内刷检在不到10秒内完成，刷取物立即进行革兰氏染色以及需氧菌和厌氧菌定量培养。根据临床随访和治疗反应，确诊了11例细菌性肺炎发作和5例非细菌性肺部疾病。PSB革兰氏染色证实所有病例均为下呼吸道采样。PSB培养显示，9/11（82%）的肺炎病例存在呼吸道病原体，除两份标本外，所有标本的菌落形成单位（cfu）均大于10³/ml。所有肺炎患者对特定抗生素均有反应。所有非细菌性疾病患者的PSB培养菌落数均小于10³CFU/ml，其肺部病变在未使用抗生素治疗的情况下有所改善。尽管有两名患者出现短暂性支气管痉挛或呼吸暂停，但该操作耐受性良好。鼻气管PSB的经验有限，但在选定的疑似细菌性肺炎患者中，该操作似乎是一种可靠且相对安全的替代诊断方法。进行定量培养对于提高其诊断准确性是必要的。
