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1、临床病原学检验,上海交通大学医学院洪秀华教授,前 言,实验诊断学(laboratory diagnosis)是诊断学的一部分,它是基础医学向临床医学过渡的桥梁课程之一。实验诊断学的任务是将临床检验所提供的检验信息，通过医师的分析和思维，科学地应用于临床诊断、鉴别诊断、观察病情、判断预后、预防疾病的一门学科，特别强调在循证实验医学的原则下推行“实验的优化组合应用”和“在实验监测下作个体化治疗的应用”，实验诊断学也可称为临床检验诊断学。因此，它是医学生的必修课，必须加以重视。,Clinical laboratory or medical laboratory is intended to be i
2、nclusive and cover all institutions providing a pathology service or performing tests on specimens from human beings.It is for the biological,microbiological,immunological,chemical,immunohematological,hematological,biophysical,cytological,pathological,or other testing of materials derived from the h
3、uman body for the purpose of providing information for the diagnosis,prevention,treatment of disease or the assessment of the health of human beings.,一、临床病原体检查目的,临床病原体检查目的:是确定感染的发生和性质，在疾病早期提供恰当的治疗方案，并采取有效的预防措施，防止感染传播造成的危害。,二、各种不同病原体的实验诊断方法遵循以下基本原则,1.正确、规范采集和运送标本。2.直接显微镜查见病原体或检出病原体抗原，借助分子生物学的方法检测病原体核
4、酸，结合病人的病史、症状或体征，快速作出初步诊断。,二、各种不同病原体的实验诊断方法遵循以下基本原则：,3.初步诊断同时，对病原体进行分离与鉴定。4.检测机体对病原体的免疫产物。5.参与临床选择抗菌药物，指导和监控微生物的治疗方案，避免 耐药菌株的产生。,泌尿生殖道标本：根据不同疾病采集不同标本，如性传播疾病常取尿道口分泌物、外阴糜烂面病灶边缘分泌物阴道宫颈口分泌物和前列腺液等。除淋病奈瑟菌保温送检外，所有标本4保存。,三、标本的采集和运送,血液标本采血时间：发热初期和高峰期，已用抗菌药物治疗者在下次用药前。采血量：成人1020ml，婴儿和儿童为12ml。运送：血液置于含抗凝集聚茴香脑磺酸钠无
5、菌瓶中送检。,脑脊液标本脑脊液应立即保温送检或床边接种（引起脑膜炎的病原体脑膜炎奈瑟菌、肺炎链球菌等抵抗力弱）胸水、腹水和心包液等含菌量少宜采集较大量标本送检。,尿液标本应注意无菌操作，取清洁中断尿。厌氧培养采用膀胱穿刺法、无菌厌氧小瓶运送，排尿困难者可导尿。,呼吸道标本标本种类：鼻咽拭子、痰、通过气管收集的标本。合格的痰标本:扁平上皮细胞25个/高倍视野。,粪便标本：含脓、血、粘液粪便置于清洁容器中送检。根据细菌不同种类选用合适运送培养基，如疑为副溶血弧菌引起腹泻的粪便置于碱性蛋白胨水或卡-布运送培养液。,创伤、组织和脓肿标本采集部位首先清除污物，防止表面污染菌混入。采集方法：大面积创伤不同
6、部位采集多份标本。开放性脓肿无菌棉试采取脓液及病灶深部分泌物。厌氧菌感染取脓后立即排尽注射器内空气。,血清标本用于检测患者特异性抗体效价采集血液置无菌管中，自然凝固、血块收缩后吸取血清，56加热30min以灭活补体成分。灭活血清保存于-20,Specimen Collection,Successful laboratory diagnosis of a microbial infection depends on many factors beginning with a well-collected sample.Proper specimen selection,collection,an
7、d transport are all essential to ensure that a specimen is representative of the disease process and minimally contaminated with microorganisms present in adjacent tissues.,Site and Timing,Collect the sample from the correct anatomic site.eg.a superficial sample of a lesion is not useful in identify
8、ing the cause of a deep wound infection.The timing of sample collection is also important.eg,when submitting a specimen for bacterial culture,samples should be collected before the administration of antibiotics,Collection Techniques,Sufficient volume Sterile technique and equipment.After collection,
9、the specimen must be placed in an appropriately labeled leak-proof container.,Transport of Specimens,Rapid,optimally in less than 2 hours.For delays in transport,most specimens should be refrigerated.Exceptions:blood,cerebrospinal fluid(CSF),and specimens to be examined for anaerobes,fastidious organisms such as Neisseria gonorrboeae and Bordetella pertussis,and Trichomonas vaginalis,all of which should be maintained at room temperature.,
