中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2014年
4期
228-231
,共4页
张应金%黄润忠%梁凤潇%苏永棉%张金凤
張應金%黃潤忠%樑鳳瀟%囌永棉%張金鳳
장응금%황윤충%량봉소%소영면%장금봉
降钙素原%呼吸机相关性肺炎%临床肺部感染评分
降鈣素原%呼吸機相關性肺炎%臨床肺部感染評分
강개소원%호흡궤상관성폐염%림상폐부감염평분
Procalcitonin%Ventilator associated pneumonia%Clinical pulmonary infection score
目的 探讨血清降钙素原(procalcitonin,PCT)在新生儿呼吸机相关性肺炎(ventilator associated pneumonia,VAP)诊治中的价值.方法 按照7d内是否发生VAP,将2012年1月至2013年12月入住我院NICU需有创机械通气的60例患儿分为VAP组(30例)和非VAP组(30例),VAP组患儿再按照随机数字表法随机分为PCT组(15例)和对照组(15例).两组患儿于机械通气前及机械通气后测定血清PCT、C反应蛋白(C-reactive protein,CRP)及WBC计数,比较各炎症指标对VAP诊断的敏感性、特异性、阳性预测值和阴性预测值.结果 VAP组患儿机械通气前后血清PCT水平比较差异有统计学意义(t=1.58,P=O.000),分别为(0.37±0.25) μg/L和(2.17±1.46) μg/L;非VAP组机械通气前后PCT水平无明显变化(t=3.67,P=0.055).两组患儿机械通气前后血清CRP与WBC计数差异均无统计学意义(P均＞0.05).以PCT≥0.40 μg/L、CRP≥28 mg/L、WBC≥10×109/L为阳性阈值,三指标对诊断VAP的敏感性分别为93.3％、73.3％、66.7％,其中PCT的特异性为73.3％,阳性预测值为77.8％,阴性预测值为91.7％.PCT组和对照组抗生素使用时间分别为(12.6±5.6)d和(15.1±9.1)d,两者差异有统计学意义(P=0.018).结论 血清PCT在VAP诊断中有较高的敏感性和特异性,PCT联合临床肺部感染评分可以提高VAP诊断的准确性,及时监测血清PCT有助于VAP的早期诊断,以血清PCT指导抗生素治疗可缩短抗生素疗程.
目的 探討血清降鈣素原(procalcitonin,PCT)在新生兒呼吸機相關性肺炎(ventilator associated pneumonia,VAP)診治中的價值.方法 按照7d內是否髮生VAP,將2012年1月至2013年12月入住我院NICU需有創機械通氣的60例患兒分為VAP組(30例)和非VAP組(30例),VAP組患兒再按照隨機數字錶法隨機分為PCT組(15例)和對照組(15例).兩組患兒于機械通氣前及機械通氣後測定血清PCT、C反應蛋白(C-reactive protein,CRP)及WBC計數,比較各炎癥指標對VAP診斷的敏感性、特異性、暘性預測值和陰性預測值.結果 VAP組患兒機械通氣前後血清PCT水平比較差異有統計學意義(t=1.58,P=O.000),分彆為(0.37±0.25) μg/L和(2.17±1.46) μg/L;非VAP組機械通氣前後PCT水平無明顯變化(t=3.67,P=0.055).兩組患兒機械通氣前後血清CRP與WBC計數差異均無統計學意義(P均＞0.05).以PCT≥0.40 μg/L、CRP≥28 mg/L、WBC≥10×109/L為暘性閾值,三指標對診斷VAP的敏感性分彆為93.3％、73.3％、66.7％,其中PCT的特異性為73.3％,暘性預測值為77.8％,陰性預測值為91.7％.PCT組和對照組抗生素使用時間分彆為(12.6±5.6)d和(15.1±9.1)d,兩者差異有統計學意義(P=0.018).結論 血清PCT在VAP診斷中有較高的敏感性和特異性,PCT聯閤臨床肺部感染評分可以提高VAP診斷的準確性,及時鑑測血清PCT有助于VAP的早期診斷,以血清PCT指導抗生素治療可縮短抗生素療程.
목적 탐토혈청강개소원(procalcitonin,PCT)재신생인호흡궤상관성폐염(ventilator associated pneumonia,VAP)진치중적개치.방법 안조7d내시부발생VAP,장2012년1월지2013년12월입주아원NICU수유창궤계통기적60례환인분위VAP조(30례)화비VAP조(30례),VAP조환인재안조수궤수자표법수궤분위PCT조(15례)화대조조(15례).량조환인우궤계통기전급궤계통기후측정혈청PCT、C반응단백(C-reactive protein,CRP)급WBC계수,비교각염증지표대VAP진단적민감성、특이성、양성예측치화음성예측치.결과 VAP조환인궤계통기전후혈청PCT수평비교차이유통계학의의(t=1.58,P=O.000),분별위(0.37±0.25) μg/L화(2.17±1.46) μg/L;비VAP조궤계통기전후PCT수평무명현변화(t=3.67,P=0.055).량조환인궤계통기전후혈청CRP여WBC계수차이균무통계학의의(P균＞0.05).이PCT≥0.40 μg/L、CRP≥28 mg/L、WBC≥10×109/L위양성역치,삼지표대진단VAP적민감성분별위93.3％、73.3％、66.7％,기중PCT적특이성위73.3％,양성예측치위77.8％,음성예측치위91.7％.PCT조화대조조항생소사용시간분별위(12.6±5.6)d화(15.1±9.1)d,량자차이유통계학의의(P=0.018).결론 혈청PCT재VAP진단중유교고적민감성화특이성,PCT연합림상폐부감염평분가이제고VAP진단적준학성,급시감측혈청PCT유조우VAP적조기진단,이혈청PCT지도항생소치료가축단항생소료정.
Objective To explore the value of procalcitonin (PCT) in diagnosis and treatment of neonatal ventilator associated pneumonia(VAP).Methods Sixty neonates needed invasive mechanical ventilation admitted to our NICU from Jan 2012 to Dec 2013 were divided into VAP group (30 cases) and nonVAP group (30 cases),depending on whether the neonates developed to VAP or not in 7 days.The VAP group then was randomly divided into PCT group (15 cases) and control group(15 cases) according to random number table.The levels of serum PCT,C-reactive protein(CRP) and WBC count were detected when the neonates suspected VAP before and after mechanical ventilation.Besides,the sensitivity,specificity,positive and negative predictive values for PCT,CRP and WBC were calculated in the diagnosis of VAP.Results The serum levels of PCT in VAP group had significant difference before and after mechanical ventilation (t =1.58,P =0.000),the levels of PCT were (0.37 ± 0.25) μg/L and (2.17 ± 1.46) μg/L respectively.The levels of PCT in non-VAP group had no significant difference (t =3.67,P =0.055).The levels of CRP and WBC showed no significant differences between VAP and non-VAP group before mechanical ventilation (P ＞ 0.05).Taking PCT ≥0.40 μg/L,CRP≥ 28 mg/L and WBC ≥ 10 × 109/L as the cut off value,the sensitivity of the three indicators diagnosis of VAP were 93.3％,73.3％ and 66.7％ respectively.PCT had the highest sensitivity 93.3 ％,specificity 73.3％,positive predictive 77.8％ and negative predictive 91.7％.The antibiotic duration of PCT group was (12.6 ± 5.6) d compared with (15.1 ± 9.1) d in control group (P =0.018).Conclusion Serum PCT has high sensitivity and specificity in the diagnosis of VAP,PCT combined with clinical pulmonary infection score can improve the diagnostic accuracy of VAP,early diagnosis and timely monitoring of serum PCT is helpful in VAP.PCT guidance substantially reduces antibiotic use in VAP,so that timely surveillance of PCT is necessary for patients on ventilator.
