CAJ | 학술논문

目的探讨血清降钙素原（PCT）及简化临床肺部感染评分（CPIS）对呼吸机相关性肺炎（VAP）患者预后评估的价值。方法选取 VAP 患者127例，根据预后分为生存组88例，死亡组39例，对患者行急性生理学和慢性健康状况评分Ⅱ（APACHEⅡ），记录确诊 VAP 当日和第4天PCT 及其他临床生化指标，计算 CPIS 评分，应用 SPSS 17．0软件分析 PCT、CPIS 对 VAP 患者预后的影响。结果确诊 VAP 第1天，死亡组与生存组 PCT 水平分别为（4．76±0．14）ng／ml 和（3．54±0．13）ng／ml，两组差异有统计学意义（P ＜0．05）；发病第4天后死亡组 PCT 水平呈上升趋势，为（8．36±0．15）ng／ml，存活组 PCT 水平呈下降趋势，为（2．70±0．12）ng／ml，两者比较差异有统计学意义（P ＜0．05）。确诊 VAP 第1天，死亡组与生存组 CPIS 评分分别为（3．92±0．14）分和（3．55±0．11）分，两组比较差异有统计学意义（P ＜0．05）；发病第4天死亡组 CPIS 评分呈上升趋势，为（7．00±0．21）分，存活组 CPIS 评分呈下降趋势，为（2．67±0．10）分，两者比较差异有统计学意义（P ＜0．05）。死亡组 APACHEⅡ评分高于存活组，差异有统计学意义（P ＜0．05）。相关分析表明，第1天和第4天 PCT 水平、第4天 CPIS 评分、APACHEⅡ评分均与病情严重程度呈负相关，是影响患者预后的危险因素。结论CPIS 评分及 PCT 水平的持续增加提示 VAP 患者预后差，动态监测 PCT 及 CPIS 对 VAP 患者判断病情严重程度及评估预后，有较高的临床指导价值。
목적탐토혈청강개소원（PCT）급간화림상폐부감염평분（CPIS）대호흡궤상관성폐염（VAP）환자예후평고적개치。방법선취 VAP 환자127례，근거예후분위생존조88례，사망조39례，대환자행급성생이학화만성건강상황평분Ⅱ（APACHEⅡ），기록학진 VAP 당일화제4천PCT 급기타림상생화지표，계산 CPIS 평분，응용 SPSS 17．0연건분석 PCT、CPIS 대 VAP 환자예후적영향。결과학진 VAP 제1천，사망조여생존조 PCT 수평분별위（4．76±0．14）ng／ml 화（3．54±0．13）ng／ml，량조차이유통계학의의（P ＜0．05）；발병제4천후사망조 PCT 수평정상승추세，위（8．36±0．15）ng／ml，존활조 PCT 수평정하강추세，위（2．70±0．12）ng／ml，량자비교차이유통계학의의（P ＜0．05）。학진 VAP 제1천，사망조여생존조 CPIS 평분분별위（3．92±0．14）분화（3．55±0．11）분，량조비교차이유통계학의의（P ＜0．05）；발병제4천사망조 CPIS 평분정상승추세，위（7．00±0．21）분，존활조 CPIS 평분정하강추세，위（2．67±0．10）분，량자비교차이유통계학의의（P ＜0．05）。사망조 APACHEⅡ평분고우존활조，차이유통계학의의（P ＜0．05）。상관분석표명，제1천화제4천 PCT 수평、제4천 CPIS 평분、APACHEⅡ평분균여병정엄중정도정부상관，시영향환자예후적위험인소。결론CPIS 평분급 PCT 수평적지속증가제시 VAP 환자예후차，동태감측 PCT 급 CPIS 대 VAP 환자판단병정엄중정도급평고예후，유교고적림상지도개치。
Objective To investigate the role of procalcitonin (PCT) level and clinical pulmonary infection score(CPIS)in prognosis evaluation of patients with ventilator associated pneumonia (VAP).Methods 127 patients with VAP were enrolled and divided into two groups based on their prognosis:survival group(88 patients)and death group(39 patients).PCT,acute physiology and chronic health evaluation II(APACHEII),CPIS score and other clinical examination results on the day when VAP was diagnosed were recorded.PCT levels,biochemical examination results and CPIS score on the forth day after diagnosis were assessed.The effects of PCT and CPIS scores on the prognosis of patients with VAP were discussed.All the data was analyzed by software SPSS 17.0.Results On the day of VAP diagnosis, there was a significant difference in PCT level between survival group and death group(4.76 ±0.14, 3.54 ±0.13)ng/ml.And CPIS score in survival group was significantly higher than that in death group (3.92 ±0.14,3.55 ±0.11).On the forth day after VAP diagnosis,PCT level and CPIS score both signif-icantly increased in death group(8.36 ±0.15,7.00 ±0.21)ng/ml while both significantly decreased in survival group(2.70 ±0.12,2.67 ±0.10)ng/ml compared to the day of diagnosis.For APACHE II score,the data suggested it was higher in death group than in survival group(P <0.05).It was indicated that PCT level,CPIS score and APACHE II score were inversely related with the severity of the disease, which dangerously affecting the prognosis of VAP patients.Conclusion The continuously increasing of PCT level and CPIS score indicate poor prognosis of VAP patients.It would be very helpful for clinical evaluation to dynamically monitor PCT level and CPIS score of VAP patients.