急性肺炎之細胞學診斷：比較米勒－華盛頓分級系統痰篩檢法和經氣管抽痰術

利用一般咳痰檢查肺炎之致病菌，常因口腔之污染，使吾人對其培養結果產生疑惑。Murrary-Washington grading system（米勒－華盛頓分級系統）痰篩檢法中認為當痰中多核性白血球在100倍顯微鏡放大下大於25個而上皮細胞小於10個，這種經篩檢過痰檢體認為是由深部呼吸道咳出之痰，較少被口咽污染，且臨床細菌學意義。海軍總醫院自1987年6月6日至次年6月6日對47例，年齡從17歲至24歲之罹患社區感染肺炎之役男，實施經氣管抽痰術及利用米勒－華盛頓分級系統痰篩檢法進行肺炎之細菌學檢查。兩種方法所獲得之痰檢體經培養，其結果高度一致，配合比率為74.4%。我們認為米勒－華盛頓分級系統痰篩檢法做法簡單，屬於非侵犯性檢查，無安全顧慮；率病人有能力咳痰時，不失為一良好的檢查方法。而屬侵犯性檢查之經氣管抽痰術，須考慮一些併發症如皮下或中隔腔氣腫，焦慮感產生及出血問題。

關鍵字

肺炎；米勒－華盛頓分級痰篩檢法；經氣管抽痰術

並列摘要

Infections of the lower respiratory tract usually were evaluated bacteriologically by examination of expectorated sputum. However, results of these examinations were often difficult to evaluate as expectorated sputum was contaminated by normal flora of the upper respiratory tract. The Murrary and Washington grading sputum samples according to the number of epithelial cells and number of neutrophils was used in this study. Less than 10 epithelial cells and greater than 25 neutrophils per low-power field were thought to represent an accurate sample of lower respiratory tract secretions with minimal contamination by oropharyngeal flora. Bacteriologic analysis of 47 adult patients with acute, community-acquired pneumonia were performed by both the Murrary & Washington grading system and transtracheal aspiration. The grading system and transtracheal aspiration specimens demonstrated 35 of 47 patients with the same results. Data collected suggests procurement of Murrary and Washington grading system sputums where a noninvasive technique could be simply carried out at no risk to the patient, compared with the potential risk involved in sampling lower respiratory tract secretions by transtracheal aspiration, even had complications such as subcutaneous or mediastinal emphysema and acute anxiety.

並列關鍵字

Pneumonia ； Murrary and Washington grading system ； Transtracheal aspiration

國際替代計量

急性肺炎之細胞學診斷：比較米勒－華盛頓分級系統痰篩檢法和經氣管抽痰術

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