CAJ | 학술논문

目的探讨血清降钙素原与肺部感染评分(clinical pulmonary infection score,CPIS)的动态变化,对肺结核患者发生呼吸机相关肺炎(ventilator associated pneumonia,VAP)的诊断价值及疗效评估.方法回顾性分析广州市胸科医院重症监护室2009年6月1日至2014年12月30日58例VAP患者的临床资料,将患者分为肺结核组与非肺结核组;观察两组患者气管插管时,发生VAP第1、3、7天PCT和CPIS评分的变化;比较两组患者发生VAP时PCT及CPIS评分在不同时间点的差异.统计学方法应用SPSS 19.0进行数据处理.计数资料采用x2检验,计量资料采用均数±标准差(x-±s)表示,组间比较采用t检验,组内比较采用重复测量方差分析及Bonferroni法,用Pearson直线相关分析,以P＜0.05为差异具有统计学意义.结果两组患者VAP发生的相同观察时间点,其血清PCT及CPIS评分差异无统计学意义(P＞0.05);组内比较PCT的F值为13.036,CPIS评分的F值178.349,两组患者发生VAP第1天和第3天PCT、CPIS评分与气管插管时比较差异均有统计学意义(P＜0.05);而第7天的PCT及CPIS评分与气管插管时比较,两组患者差异均无统计学意义(P＞0.05).生存患者的机械通气、ICU住院和总住院时间与VAP第7天PCT的相关系数分别为0.92,0.83,0.71;而与第7天CPIS评分的相关系数分别为0.83,0.74,0.70,均显著相关(P＜0.05).结论早期监测活动性肺结核患者血清PCT及CIPS评分,可以判断VAP的发生,其动态变化可预测VAP病情严重程度和预后.
목적 탐토혈청강개소원여폐부감염평분(clinical pulmonary infection score,CPIS)적동태변화,대폐결핵환자발생호흡궤상관폐염(ventilator associated pneumonia,VAP)적진단개치급료효평고.방법 회고성분석엄주시흉과의원중증감호실2009년6월1일지2014년12월30일58례VAP환자적림상자료,장환자분위폐결핵조여비폐결핵조;관찰량조환자기관삽관시,발생VAP제1、3、7천PCT화CPIS평분적변화;비교량조환자발생VAP시PCT급CPIS평분재불동시간점적차이.통계학방법응용SPSS 19.0진행수거처리.계수자료채용x2검험,계량자료채용균수±표준차(x-±s)표시,조간비교채용t검험,조내비교채용중복측량방차분석급Bonferroni법,용Pearson직선상관분석,이P＜0.05위차이구유통계학의의.결과 량조환자VAP발생적상동관찰시간점,기혈청PCT급CPIS평분차이무통계학의의(P＞0.05);조내비교PCT적F치위13.036,CPIS평분적F치178.349,량조환자발생VAP제1천화제3천PCT、CPIS평분여기관삽관시비교차이균유통계학의의(P＜0.05);이제7천적PCT급CPIS평분여기관삽관시비교,량조환자차이균무통계학의의(P＞0.05).생존환자적궤계통기、ICU주원화총주원시간여VAP제7천PCT적상관계수분별위0.92,0.83,0.71;이여제7천CPIS평분적상관계수분별위0.83,0.74,0.70,균현저상관(P＜0.05).결론 조기감측활동성폐결핵환자혈청PCT급CIPS평분,가이판단VAP적발생,기동태변화가예측VAP병정엄중정도화예후.
Objective To explore the value of the variation of clinical pulmonary infection score (CPIS) and serum procalcitonin (PCT) in diagnosis and treatment evaluation in patients suffering from active pulmonary tuberculosis with complication of ventilator-associated pneumonia (VAP).Methods A retrospective analysis was carried out in 58 VAP patients from June 1,2009 to December 30,2014 in the respiratory intensive care unit.According to the patient suffering from tuberculosis or not,patients were divided into two groups.The PCT and CPIS score changes were observed in the two groups of patients with intra-tracheal intubation 1,3 and 7 days after VAP onset.Comparisons of CPIS and PCT scores were carried out between two groups at different intervals after VAP onset.Data were statistically processed by SPSS 19.0.Count data were tested by x2,and measurement data were expressed by mean ± standard deviation (x-±s).The comparison within the groups was made by t test,whereas the comparison between the groups was by means of repeated measure analysis of variance and Bonferroni test;Pearson linear correlation analysis was used,and P ＜ 0.05 was considered statistically significant.Results At the same observation interval in two groups of patients with VAP,there was no significant difference in the serum levels of PCT and CPIS score (P ＞ 0.05);there were significant differences in PCT and CPIS scores between VAP occurred at the first day,the third day and at time of intra-tracheal intubation in two groups (P ＜ 0.05).However,comparison of PCT and CPIS scores at the seventh day,the differences were not statistically significant (P ＞ 0.05).In addition,at the 7 days the correlation coefficient between PCT and survival patients' mechanical ventilation,days in ICU and total length of hospital stay were 0.92,0.83,and 0.71,respectively,yet the 7-day CPIS score correlation coefficients were 0.83,0.74 and 0.70,(both P ＜ 0.05).Conclusions Early monitoring of serum PCT and CIPS score of pulmonary tuberculosis patients can judge the incidence of VAP,and the variations of PCT and CIPS score can predict the severity and prognosis of the disease as well.