Clementsen P S, Pedersen S S
Medicinsk-lungemedicinsk afdeling Y, Amtssygehuset i Gentofte.
Ugeskr Laeger. 1996 Sep 30;158(40):5595-9.
Pneumonia is a common complication in patients requiring mechanical ventilation and the mortality is high. The diagnosis is difficult to establish in spite of many available diagnostic techniques: Aspiration from endotracheal tube or tracheostomy, fiberbronchoscopy with bronchial aspiration, protected specimen-brush (PSB), bronchoalveolar lavage (BAL), transbronchial biopsy or percutaneous lung needle aspiration or open lung biopsy. A review of the literature is given. It is concluded that PSB and BAL combined with quantitative cultures are valid tools, but there is no conclusion as to the superiority of one over the other. With the use of prior antibiotics the rate of false negatives increases and the specificity and sensitivity are lowered. However, we do need a prospective, randomized trial in order to demonstrate that invasive methods in fact decrease morbidity and mortality in the patients compared with clinical judgement alone.
肺炎是需要机械通气的患者常见的并发症，死亡率很高。尽管有许多可用的诊断技术，但诊断仍难以确立，这些技术包括：经气管内导管或气管造口吸引、纤维支气管镜检查及支气管吸引、防污染样本毛刷（PSB）、支气管肺泡灌洗（BAL）、经支气管活检或经皮肺穿刺抽吸或开胸肺活检。本文对相关文献进行了综述。得出的结论是，PSB和BAL联合定量培养是有效的工具，但对于二者谁更具优势尚无定论。使用过抗生素会增加假阴性率，降低特异性和敏感性。然而，我们确实需要进行一项前瞻性随机试验，以证明与单纯临床判断相比，侵入性方法实际上能降低患者的发病率和死亡率。
