Objective To investigate a suspected outbreak of hospital-acquired infections caused by Mycobacterium chelonae related to flexible bronchoscope (hereinafter referred to as “bronchofibroscope”) and apply targeted high-throughput sequencing (tNGS) technology for etiological analysis, providing references for controlling hospital infection outbreaks. Methods A retrospective survey of patients who were detected with Mycobacterium chelonae through tNGS testing of bronchoalveolar lavage fluid (BALF) after bronchofibroscopy at the Zhengdong District, People’s Hospital of Henan University of Chinese Medicine, People’s Hospital of Zhengzhou between May 1, 2018 and March 18, 2024. The causes were investigated through comprehensive measures including on-site epidemiological surveys and environmental health assessments, and intervention measures were developed and evaluated for effectiveness. Results A total of 52 patients were included. Mycobacterium chelonae was detected in 30 patients, nosocomial infection was excluded in all cases. The suspicious contaminated bronchofibroscope lavage fluid and its cleaning and disinfection equipment, environment and other samples were collected. The traditional microbial culture results were negative. The tNGS results showed that Mycobacterium chelonae was detected in bronchofibroscope lavage fluid (sequence number 156), and all the patients with Mycobacterium chelonae detected in BALF used the bronchofibroscope. It was judged that this event was a pseudo-outbreak of nosocomial infection caused by the contamination of bronchofibroscope with the patient’s BALF. After three months of continuous follow-up after the comprehensive control measures were taken, Mycobacterium chelonae was not detected by tNGS in bronchofibroscope lavage fluid or patients’ BALF. All patients in the hospital improved and discharged without any new cases. The pseudo-outbreak of nosocomial infection was effectively controlled. Conclusions There are many links in the reprocessing of bronchofibroscope, which is easy to cause pollution, and the management needs to be strengthened. tNGS detection has the characteristics of high efficiency, few background bacteria and clear pathogen spectrum, which can be used as a supplementary means for the investigation of nosocomial infection outbreaks, and is of great significance for identifying the source of infection and determining the transmission route.
目的探讨纤维支气管镜（纤支镜）在体外循环术后机械通气患者中的应用。 方法回顾性分析2014年1～12月行纤支镜检查76例体外循环术后机械通气患者的临床资料，男45例、女31例，年龄21～71（42.8±6.3）岁。其中行二尖瓣置换术35例，主动脉瓣置换术11例，二尖瓣置换术+主动脉瓣置换术17例，冠状动脉旁路移植术5例，升主动脉+主动脉全弓或半弓人工血管置换术8例。术前心功能Ⅱ级25例、Ⅲ级39例、Ⅳ级12例。术前合并中、重度肺动脉高压13例，感染性心内膜炎5例。 结果76例患者中气道大量分泌物59例，气道严重充血、水肿明显9例，痰痂阻塞气管导管3例，血痂阻塞气管导管2例，导管部分闭塞2例，气道轻微渗血1例。59例经纤支镜检查吸出气道分泌物后，肺部湿啰音较检查前明显减轻，呼吸状态明显好转；其余17例也经纤支镜检查进行准确诊断和有效处理。本组患者在纤支镜检查中顺利完成痰液标本采集共31例，未发生缺氧、心律失常和出血等操作并发症。 结论体外循环术后机械通气患者行纤支镜检查，在维持呼吸道通畅、正确指导抗生素应用、辅助诊断治疗中有积极作用。
目的:探讨纤维支气管镜(简称纤支镜)肺泡灌洗术在治疗肺部感染性疾病的疗效。方法:共从内科系统中入选社区获得性肺炎和医院获得性肺炎患者122例,将其分为二组,治疗组:传统治疗加纤支镜肺泡灌洗术治疗肺部感染,共52例;对照组:传统方法治疗肺部感染,共70例。结果:两组病例在发热时间,咳嗽,咳痰及肺部罗音消失时间,住院日,抗生素使用时间,治愈率和死亡率方面对比均有显著性差异(Plt;0.05)。结论:纤支镜肺泡灌洗术在治疗肺部感染性疾病的疗效确切,且术中危险性小,值得推广。
Objective To compare the diagnostic value of sterile sputumsuction tube with protected specimen brush in mechanically ventilated patients with serious lung infection, and explore the safety and efficacy of bronchofibroscope combining mechanical ventilation in the treatment of severe lung infection.Methods Seventy-four severe lung infection patients with invasive mechanical ventilation support were recruited in the study. Based on the routine treatment, the subjects were randomly divided into a control group received only mechanical ventilation, and a treatment group received sputum aspiration and bronchial lavage by bronchofibroscope combiningmechanical ventilation. Lower respiratory tract secretion was collected to analyze the bacterial etiology with sterile sputum suction tube in the control group, and with protectedspecimen brush in the treatment group. Results The positive rate of sputum suction tube and protected specimen brush was 70. 27% and 75. 68% , respectively, with no statistical difference between the two groups ( P gt; 0. 05) . The PaO2 of the treatment group increased and PaCO2 decreased obviously after sputum aspiration and bronchial lavage by bronchofibroscope ( P lt; 0. 01) . The total effective rate was also highly increased, and the heart rate and respiration were stable in the treatment group. The time of mechanical ventilation and the length of ICU stay were all shortened in the treatment group compared with the control group. Conclusions Sterile sputum suction tube can not only acquire accurate pathogen, but also is a simple and economical method for patients with severe lung infection with mechanical ventilation. Sputum aspiration and bronchial lavage with bronchofibroscope combining mechanical ventilation are effective and safe treatment for patients with severe lung infection.
ObjectiveTo evaluate the safety and efficacy of non-invasive positive pressure ventilation (NIPPV) combined with fiberoptic bronchoscopy(FB) on acute exacerbation of chronic obstructive puhmonary disease (AECOPD) patients with acute respiratory failure. MethodsA prospective study was conducted on the AECOPD patients with respiratory failure in respiratory intensive care unit of Tangdu Hospital of Fourth Military Medicine University from February 2010 to February 2011.They were randomly divided into a case group and a control group.The case group was administrated FB and lavage after one hour of NIPPV treatment.The control group was administrated NIPPV without FB and lavage.Other treatment regimen was the same in two groups. ResultsThere were 51 subjects recruited in the study, 25 subjects in the case group and 26 subjects in the control group.All variables at baseline were matched (P > 0.05).All variables improved after one hour of NIPPV before FB, without significant difference between two groups (P > 0.05).During the period of FB, heart rate in the case group was faster than that in the control group (P < 0.05), and other variables were not significantly different between two groups (P > 0.05).Both groups received NIPPV for one hour after FB, the variables including heart rate, respiratory rate, pH, PaO2, PaCO2 were statistically significant between two groups(P < 0.05).At the time of 24 hours after FB, the variables including mean arterial pressure, heart rate, respiratory rate, pH, PaO2 and PaCO2 in the case group were nearly recovered, and differences between two groups were significant (P < 0.05).The positive rate of sputum culture was significantly higher in the case group than that in the control group[88.0%(22/25) vs.58.6%(14/26)].Success rate in the case group were obviously superior to that in control group.The cases of failure, death and refusing in the case group were lower than those in the control group.Complications in two groups had no significant difference (P > 0.05).There was not serious complication such as hear arrest, hemoptysis and apnea during the process of NIPPV combined with early FB. Conclusion It deserves to be used in clinic because of the safety, efficacy and feasible for most of AECOPD patients through NIPPV combined with early FB.
【摘要】 目的 分析护理干预对纤维支气管镜检查患者的心理影响。方法 2008年1月—12月，通过对100例患者的问卷调查及临床观察,总结分析其心理特点及所采取的护理干预措施的影响。结果 纤维支气管镜检查患者的心理特点有:恐惧心理、紧张心理、消极心理等；相应的护理干预:教育性干预、行为训练、情感支持、药物干预等。结论 正确评估患者的心理特点,采取有效的护理干预,改善患者的心理状况,有利于提高患者的依从性,从而提高检查的成功率。【摘要】 目的 分析护理干预对纤维支气管镜检查患者的心理影响。方法 2008年1月—12月，通过对100例患者的问卷调查及临床观察,总结分析其心理特点及所采取的护理干预措施的影响。结果 纤维支气管镜检查患者的心理特点有:恐惧心理、紧张心理、消极心理等；相应的护理干预:教育性干预、行为训练、情感支持、药物干预等。结论 正确评估患者的心理特点,采取有效的护理干预,改善患者的心理状况,有利于提高患者的依从性,从而提高检查的成功率。