Rodríguez de Castro F, Solé Violán J, Rey López A, Martín González J C, Acosta Fernández O, Caminero Luna J A, Cabrera Navarro P
Sección de Neumología, Hospital Universitario Nuestra Señora del Pino, Facultad de Ciencias Médicas y de la Salud, Universidad de Las Palmas de Gran Canaria.
Arch Bronconeumol. 1994 Apr;30(4):188-91.
The diagnosis of nosocomial pneumonia is especially difficult in intubated patients due to the low specificity of their clinico-radiological signs. The objective of this study was to evaluate the usefulness of basing diagnosis on elastin fibers (EF) in bronchoaspirate (BAS) as an indication of pneumonia in mechanically-ventilated (MV) patients. Forty-seven MV patients suspected of having nosocomial pneumonia were studied prospectively. Fiber bronchoscopy was carried out on all patients and samples were obtained using a protected catheter brush (PCB) and bronchoalveolar lavage (BAL). A purulent sample of BAS was also examined, after addition of 40% KOH, to determine the presence of EF. EF was found in 15 patients, 11 of whom had pneumonia while 3 more had necrotizing pneumonia (sensitivity 52%, specificity 85%). Ten of the 17 microorganisms isolated in the cases of EF positive pneumonia were gram negative, although the germ found most often was S. aureus. There were no differences in the prognosis for pneumonia patients who were EF positive and those who were EF negative. In conclusion, once necrotizing pneumopathology has been ruled out, the presence of EF in BAS may offer reasonable support for firm diagnosis in some MV patients with pneumonia.
由于临床放射学征象的特异性较低，医院获得性肺炎的诊断对于插管患者尤其困难。本研究的目的是评估以支气管抽吸物（BAS）中的弹性纤维（EF）作为机械通气（MV）患者肺炎指征进行诊断的有效性。对47例疑似医院获得性肺炎的MV患者进行了前瞻性研究。对所有患者进行了纤维支气管镜检查，并使用保护性导管刷（PCB）和支气管肺泡灌洗（BAL）获取样本。还对加入40%氢氧化钾后的脓性BAS样本进行检查，以确定EF的存在。在15例患者中发现了EF，其中11例患有肺炎，另有3例患有坏死性肺炎（敏感性52%，特异性85%）。在EF阳性肺炎病例中分离出的17种微生物中有10种为革兰氏阴性菌，不过最常发现的病菌是金黄色葡萄球菌。EF阳性的肺炎患者和EF阴性的肺炎患者在预后方面没有差异。总之，一旦排除坏死性肺部病变，BAS中EF的存在可能为一些患有肺炎的MV患者的确诊提供合理依据。
