Shepherd K E, Lynch K E, Wain J C, Brown E N, Wilson R S
Department of Anaesthesia, Harvard Medical School, Massachusetts General Hospital, Boston, USA.
Crit Care Med. 1995 Nov;23(11):1829-34. doi: 10.1097/00003246-199511000-00008.
It has been inferred from previous work that 40% potassium hydroxide preparations of lower respiratory tract secretions that demonstrate elastin fibers have a 100% specificity and positive predictive value in diagnosing bacterial pneumonia in intubated, mechanically ventilated patients without the adult respiratory distress syndrome (ARDS). Our aim was to assess the specificity of 40% potassium hydroxide preparations in diagnosing bacterial pneumonia in patients with ARDS and suspected pneumonia.
Prospective, case-referral clinical study.
Referral hospital.
Of 24 patients with ARDS who were intubated and mechanically ventilated with suspected bacterial pneumonia, 22 were assessable and evaluated for this report.
Tracheo-bronchial aspirates were obtained from all patients and analyzed for elastin fibers using 40% potassium hydroxide.
Of the 22 assessable patients, ten patients did not have a complicating bacterial pneumonia. Six of these ten patients had potassium hydroxide preparations that demonstrated elastin fibers (false positives). The other four patients had preparations that did not demonstrate elastin fibers (true negatives). Specificity was 40%.
Elastin fiber preparations are not specific for diagnosing bacterial pneumonia in patients with ARDS.
根据以往研究推断，在下呼吸道分泌物的40%氢氧化钾制剂中发现弹性纤维，对于诊断未患成人呼吸窘迫综合征（ARDS）的插管机械通气患者的细菌性肺炎具有100%的特异性和阳性预测值。我们的目的是评估40%氢氧化钾制剂在诊断患有ARDS且疑似肺炎患者的细菌性肺炎时的特异性。
前瞻性病例对照临床研究。
转诊医院。
24例患有ARDS且插管机械通气并疑似细菌性肺炎的患者中，22例可纳入本报告进行评估。
从所有患者获取气管支气管吸出物，并用40%氢氧化钾分析弹性纤维。
在22例可评估患者中，10例患者未并发细菌性肺炎。这10例患者中有6例的氢氧化钾制剂显示有弹性纤维（假阳性）。另外4例患者的制剂未显示弹性纤维（真阴性）。特异性为40%。
弹性纤维制剂对于诊断ARDS患者的细菌性肺炎并无特异性。
