The Effects of Bronchoalveolar Lavage Combined with Microbiological Rapid on-site Evaluation in the Maintenance of Potential Donor Lung
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摘要:
目的 探讨BAL联合M-ROSE在潜在供肺维护中的作用。 方法 选取昆明医科大学附属甘美医院重症医学科2020年09月至2022年12月收治的符合纳入标准的脑死亡患者行BAL，留取灌洗液行M-ROSE比较病原菌检出率及初步诊断时间。根据M-ROSE结果阳性的患者采用经验性抗感染治疗，评估抗感染治疗48 h前后的氧合指数、胸部X线评分、感染指标（WBC、CRP、PCT）变化。 结果 （1）病原菌检出率比较：M-ROSE对细菌感染初步诊断结果与检验科报告的结果表现出高度一致性（Kappa = 0.921，P < 0.001）；（2）诊断时效性比较：M-ROSE初步诊断时间与常规涂片报告时间、微生物培养时间比较，差异有统计学意义（P < 0.001）；（3）抗感染治疗48 h的疗效比较：抗感染治疗前后氧合指数，白细胞，超敏C反应蛋白差异无统计学意义（P > 0.05）；抗感染治疗前后胸部X线，降钙素原差异有统计学意义（P < 0.05）。 结论 BAL联合M-ROSE在潜在供肺肺部感染中的诊断时效性高，可以为供肺维护早期抗感染治疗提供初步的依据。 Abstract:Objective To explore the effects of bronchoalveolar lavage combined with microbiological rapid on-site evaluation in potential donor lung maintenance. Methods Brain death patients who met the inclusion criteria and were admitted to the Intensive Care Unit（ICU） of Calmette Hospital Affiliated to Kunming Medical University from September 2020 to December 2022 were selected for bronchoalveolar lavage（BAL） and（BAL） and the lavage fluid were collected for M-ROSE to compare the pathogen detection rate and initial diagnosis time. According to the positive results of the microbiological rapid on-site evaluation, patients with the brain death were treated with empirical anti-infective therapy, and the oxygenation index, chest X-ray score, and the infection index（WBC, CRP, PCT） of anti-infective treatment 48 hours were evaluated. Results 1.Comparison of the detection rate of pathogenic microorganisms: The results of M-ROSE were highly consistent with a routine microbiological smear（Kappa = 0.921, P < 0.001）. 2.Comparison of diagnostic time: The initial diagnosis time of M-ROSE was significantly lower than routine microbiological smear time and microbial culture time（P < 0.001）. 3.Comparison of therapeutic effects of anti-infective therapy for 48 hours: There was no significant difference in oxygenation index, white blood cells and hypersensitive C-reactive protein before and after the anti-infective treatment（P > 0.05）. There were significant differences in procalcitonin and chest X-ray before and after the anti-infective treatment（P < 0.05）. Conclusion Bronchoalveolar lavage combined with microbiological rapid on-site evaluation has the high timeliness in the diagnosis of potential donor pulmonary infection, which can provide a preliminary basis for the early anti-infective therapy of donor lung maintenance. -
图 7 床旁胸部X线示渗出影超过1个肺叶以上，评分为3分
Figure 7. Bed side chest X-ray shows exudation of more than one lung lobe，a score of 3
图 8 床旁胸部X线示渗出影在1个肺叶以下，评分为2分
Figure 8. Bed side chest X-ray shows an exudation below one lobe，a score of 2
图 9 床旁胸部X线示少量渗出影，评分为1分
Figure 9. Bed side chest X-ray showed a small exudation，a score of 1
图 10 床旁胸部X线示无明显渗出影，评分为0分
Figure 10. Bed side chest X-ray shows no exudation，score is 0
图 12 抗感染治疗前后疗效的柱形图
*P<0.05。
Figure 12. Comparison of the efficacy of anti-infective treatment for 48 h
表 1 基本资料情况 [n（%）/（$ \bar x \pm s $）]
Table 1. Basic information [n（%）/（$ \bar x \pm s $）]
项目 数据 性别 男 29（72.5） 女 11（27.5） 年龄（岁） 44.83±11.76 待机时间（d） 8.70±3.60 脑死亡病因 脑外伤 16（40） 脑出血 18（45.0） 缺氧性脑损伤 3（7.5） 脑梗死 3（7.5） 肺疾病史 有 3（7.5） 无 37（92.5） 
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表 2 M-ROSE及常规细菌涂片结果 （n）
Table 2. M-ROSE and conventional bacterial smear results （n）
M-ROSE 检验科结果 总计 细菌阳性 混合感染 阴性 细菌阳性 17 1 1 19 混合感染 2 7 0 9 阴性 2 0 10 12 总计 21 8 11 40 注：细菌阳性为检出一种细菌；混合感染为检出2种及以上细菌。
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表 3 M-ROSE与常规涂片病原菌检出率比较[n（%）]
Table 3. Comparison of the detection rate of pathogens between M-ROSE and conventional smears [n（%）]
组别 确诊 细菌阳性 真菌阳性 M-ROSE 28（70.0） 5（12.5） 常规涂片 29（72.5） 6（15.0） χ2 0.061 0.105 P 0.805 0.745
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表 4 M-ROSE诊断时间与常规涂片、微生物培养时间比较（h）
Table 4. Comparison of M-ROSE diagnosis time with routine smear time and microbial culture time（h）
组别 组别 平均值差值 （I-J） 标准错误 显著性 95%CI 下限 上限 M-ROSE组 常规涂片组 −11.70025* 2.25942 0.000* −16.1749 −7.2256 微生物培养组 −54.47525* 2.25942 0.000* −58.9499 −50.0006 常规涂片组 M-ROSE组 11.70025* 2.25942 0.000* 7.2256 16.1749 微生物培养组 −42.77500* 2.25942 0.000* −47.2497 −38.3003 微生物培养组 M-ROSE组 54.47525* 2.25942 0.000* 50.0006 58.9499 常规涂片组 42.77500* 2.25942 0.000* 38.3003 47.2497 *. 平均值差值的显著性水平为 0.05。
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表 5 抗感染治疗48 h的疗效比较（$ \bar x \pm s $）
Table 5. Comparison of the efficacy of anti-infective treatment for 48 h（$ \bar x \pm s $）
疗效 PaO2/FiO2（mmHg） 胸片评分（分） WBC（×109/L） CRP（mg/L） PCT（mcg/L） 治疗前 233.23±181.05 1.81±0.75 12.81±7.37 119.21±77.75 7.69±12.93 治疗后 279.46±165.24 1.42±0.99 13.72±7.42 103.90±84.27 5.25±12.01 t −1.734 2.184 −1.003 1.063 2.150 P 0.095 0.039* 0.326 0.298 0.041* *P<0.05。
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