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目的 为确证胃→咽→下呼吸道逆行感染途径存在与否 ,研究胃液pH值变化与院内感染性肺炎 (Nosocomialpneumonia ,NP)发生的关系。方法 以气管切开 (或插管 )病人为对象 ,用防污染标本刷 (PSB)采集标本 ,由细菌表型分型 ,直至质粒DNA、酶切、随机扩增多态性DNA(RAPD)等基因分型 ,前瞻性观察NP的发生情况。结果 11名患者有逆行感染存在 (发生率为 2 2 % ) ,即在胃部分离出病原菌 1、2d后 ,PSB在咽部及下呼吸道也检出相同的细菌 ,应用质粒图谱、酶切图谱和RAPD等分子生物学技术进行同源性分析 ,证明其具有很高的同源性。将美蓝经胃管注入病人胃内 ,1、2d后在咽部及下呼吸道可检出蓝色分泌物。随着胃液pH值升高 ,胃内细菌定植增加 ,NP的发生率升高。结论 存在胃→咽→下呼吸道的逆行感染途径。NP的发生与胃液pH值显著相关。
Objective To confirm the existence of retrograde infection of stomach → pharynx → lower respiratory tract and study the relationship between gastric pH and the occurrence of nosocomial pneumonia (NP). Methods Tracheostomy (or intubated) patients were taken as samples. Specimens were collected with anti-contamination brush (PSB) and classified by bacterial phenotype until plasmid DNA, restriction enzyme digestion, random amplified polymorphic DNA (RAPD) Genotyping, prospective observation of the occurrence of NP. Results 11 patients had retrograde infection (the incidence was 22%). That is, PSB also detected the same bacteria in pharynx and lower respiratory tract after the pathogen was isolated from the stomach for one and two days. Plasmid map and restriction map And RAPD and other molecular biology techniques for homology analysis to prove its high homology. The blue will be injected into the patient’s stomach by the blue tube, 1d after the pharynx and the lower respiratory tract can detect blue secretions. As the pH of gastric juice increases, bacterial colonization in the stomach increases and the incidence of NP increases. Conclusion There is retrograde infection route of stomach → pharynx → lower respiratory tract. The incidence of NP was significantly correlated with gastric pH.