呼吸机相关性肺炎的评分与预后的临床意义

发布时间：2018-04-29 13:50

本文选题：机械通气 + 呼吸机相关肺部感染　；参考：《中华医院感染学杂志》2016年17期

【摘要】：目的对行机械通气患者肺部感染病原菌分布进行分析,探讨肺部感染评分(CPIS)的临床意义及感染对呼吸机相关性肺炎(VAP)预后的影响,以期为临床诊疗提供参考。方法回顾性分析2012年1月-2015年1月在医院接受机械通气治疗的80例VAP患者的临床资料,作为感染组,同时将接受机械通气未并发VAP的150例患者作为未感染组,医院同期100名健康体检者作为对照组;采用法国生物梅里埃微生物全自动鉴定仪进行病原菌鉴定分型,比较感染组与未感染组住院期间临床肺部感染评分(CPIS)和累积病死率。结果感染组患者送检标本中共分离出病原菌80株,其中革兰阴性菌42株占52.5%、革兰阳性菌31株占38.75%,真菌7株占8.75%;感染组患者FEV1、FVC、FEV1/FVC及FEV1%显著低于未感染组和对照组,差异均有统计学意义(P0.05);感染组患者PaO2及IL-10水平显著降低,而IL-6及PaCO2水平显著升高,与未感染组和对照组相比差异均有统计学意义(P0.05);感染组患者住院期间累积病死率(31.25%)显著高于未感染组(14.00%),差异有统计学意义(P0.01);感染组死亡患者CPIS显著高于存活患者,差异有统计学意义(P0.01)。结论感染可导致VAP患者肺功能下降,病死率显著增加,CPIS分值高提示此类患者预后不良。
[Abstract]:Objective to analyze the distribution of pathogenic bacteria of pulmonary infection in patients with mechanical ventilation, to explore the clinical significance of pulmonary infection score (CPIS) and the influence of infection on the prognosis of ventilator associated pneumonia (VAP), in order to provide reference for clinical diagnosis and treatment. Methods a retrospective analysis of 80 cases of VAP patients receiving mechanical ventilation in hospital in January, January 2012, was analyzed. The clinical data of the patients were treated as infection group, and 150 patients with mechanical ventilation were not infected with VAP as uninfected group, and 100 medical examiners were used as control group at the same time in the hospital. The pathogenic bacteria identification classification was carried out by the French biological microorganism automatic identification instrument, and the clinical pulmonary infection was compared between the infection group and the uninfected group. Score (CPIS) and cumulative mortality rate. Results 80 strains of pathogenic bacteria were isolated from the infected specimens, among which 42 were Gram-negative bacteria, 31 were Gram-positive and 7 were 8.75%, and FEV1, FVC, FEV1/FVC and FEV1% in the infected group were significantly lower than those in the non infection group and the control group (P0.05); infection group was statistically significant (P0.05); infection group was statistically significant (P0.05). The level of PaO2 and IL-10 decreased significantly, while the level of IL-6 and PaCO2 increased significantly, and the difference was statistically significant compared with those in the uninfected and control groups (P0.05), and the cumulative mortality rate (31.25%) during the hospitalization was significantly higher than that in the uninfected group (14%), and the difference was statistically significant (P0.01), and the CPIS in the infected patients was significantly higher than that of the survival group. The difference was statistically significant (P0.01). Conclusion infection could lead to the decrease of lung function in VAP patients, the mortality rate increased significantly, and the high score of CPIS suggested that the prognosis of these patients was poor.

【作者单位】：台州市立医院呼吸内科;台州市立医院重症医学科;
【基金】：浙江省医药卫生基金资助项目(2011A102)
【分类号】：R563.1

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