| Objective:Discuss the risk factors for intubated patients with aspiration pneumonia, and found out if Bronchoalveolar Lavage Fluid Amylase could be the biomarker for aspiration pneumonia or not.Methods:1. Study of the risk factors for intubated patients with aspiration pneumonia in ICU.This was a prospective trial. In this study, we choose the intubated patients who had hospitalized in MICU of Lanzhou University Second Hospital during October 2013 to December 2014, eliminated patients diagnosed with pneumonia within the previous week. Recorded the basic clinical features and aspiration risk factors of the patients who met the inclusion criteria. According to whether met the following criteria:1.Aspiration risk factors;2.Intutation within 72 hours (excluding ventilator associated pneumonia)met pneumonia diagnosis standard, The patients were divided into two groups, with or without aspiration pneumonia. Compared the differences between the two groups of patients in risk factors and the Baseline Characteristics,Used multivariate logistic regression to analysis the risk factors associated with aspiration pneumonia.2. Identify the diagnostic threshold of the amylase activity of BALF to aspiration pneumonia, with its’sensitivity and specificity.All of patients who met the inclusion criteria underwent fiberoptic Bronchoscopy, and the BALF a-amylase activity were measured. Bacterial, fungal culture and strain identification were performed. Inspected serum amylase and PCT at the same time, the patients were divided into two groups according they eventually developed into aspiration pneumonia or not. Drew receiver operating characteristic curve (ROC curve), and calculated the area under the curve(AUC). Assessed whether the amylase activity of BALF could be used as biomarker for aspiration pneumonia and found out the optimal threshold.Results:1.68patients met the inclusion criteria of which 6 patients Bronchoalveolar automatically discharged after three days,failed to complete the follow-up experiments,3 patients excluded because of incomplete data of the experiments,there were final 59 patients included in the study.25 of them(42.4%) eventually developed aspiration pneumonia, the mean value of amylase activity of BALF was 721.7±1384.6(U/L).34 patients (57.6%) without aspiration pneumonia, the mean value of amylase activity of BALF was 258.5±525.8(U/L).The amylase activity of BLA of aspiration pneumonia group were more than of no aspiration pneumonia group(P<0.05). According to the ROC curve, the area under the curve of the amylase activity of BLA was 0.787, (95% confidence interval,0.60-0.75). Best diagnostic threshold 105.7 U/L, sensitivity of 0.960, specificity of 0.618.2. The main risk factors for aspiration included unconsciousness, choking, difficulty swallowing, tube feeding, vomiting. the more aspiration risk factors, the higher BALFa-amylase activity level, the incidence of aspiration pneumonia was also higher. The amylase activity of BALF≥3 risk factors patients were difference more than of≤2 risk factors (1532.6±2187.2 U/L,562.3±927.9 U/L VS 97.4±18.0 U/L,43.6±15.6U/L,P<0.05)). The incidence of aspiration pneumonia of≥3 risk factors patients were difference more than of≤2 risk factors (83.3%, 53.1% VS 21.4%,0%, P<0.05).3. By single factor analysis, there were no significant difference in gender, age, body weight, blood amylase activity level, blood PCT level (P>0.05). There were significant difference in APACHE Ⅱ score, unconsciousness, difficulty swallowing-cough, tube feeding, vomiting(P<0.05). By multivariate logistic regression’s results, the main risk factors for aspiration pneumonia included unconsciousness(P=0.000, OR=1.71,95% confidence interval 1.07-2.64), choking difficulty swallowing(P=0.040, OR=3.929,95% confidence interval 1.063-14.525), vomiting(P=0.047, OR=3.975,95% confidence interval 1.020-15.491).4.37 (62.7%) of the 59 patients’BALF bacterial culture negative.The other 22 samples(37.3%) bacterial culture positive,8(36.4%) of them were Acinetobacter baumannii.5(22.7%)of them were Klebsiella pneumoniae.4(18.2) of them were Staphylococcus aureus.3(13.6) of them were Escherichia coli.1(4.5%) of them were Enterobacter cloacae.1(4.5%) of them were Pseudomonas aeruginosa.Conclusion:Consciousness, cough, difficulty swallowing, vomiting were the risk factors for aspiration pneumonia of intubated patients. The amylase activity of BLAF could be the biomarker for aspiration pneumonia, and the best diagnostic threshold is 105.7 U/L. |
PDF Full Text Request