PCT、CRP以及CPIS评分对呼吸机相关性肺炎的临床价值研究

发布时间：2018-06-08 21:01

  本文选题：呼吸机相关肺炎 + 血浆降钙素原　； 参考：《广州医科大学》2017年硕士论文

【摘要】：目的探讨PCT、CRP和CPIS评分对呼吸机相关性肺炎(VAP)的临床应用价值,探讨血清学指标PCT、CRP与CPIS的相关性。方法2013年6月至2016年6月于广州医科大学附属第一医院EICU患者633例,其中需进行有创机械通气病人435例,回顾分析后187例符合VAP。收集其血液PCT、CRP以及痰培养等检查,并对入组患者进行临床肺部感染(CPIS)评分,观察各种因素与VAP关系,分析其预后生存。统计学方法采用SPSS19.0进行统计学处理分析,计数资料以率(%)表示,计量资料以(?)±s表示,组间比较采用t检验,计数资料组间比较采用χ2检验,多因素分析采用多元线性回归分析,入组后患者生存预后使用Log Rank检验,其中p0.05认为差异具有统计学意义。结果(1)187例VAP患者中,男103例,女84例,年龄为46-101岁,平均65±12.5岁。按性别、年龄、基础病因、CPIS评分分类时,各组间VAP的发生分布见表3、图1、图2。(2)187例VAP患者中,发现有159(85.0%)例患者PCT阳性(即0.5ug/L),167(89.3%)例患者CRP阳性(即10mg/L)。按感染类型、感染菌种分类时,各组间PCT,CRP的水平无明显统计学差异(P0.05);以CPIS评分6分为界点,将VAP患者分组后对CRP及PCT水平进行统计学分析,结果发现,与≤6分组相比,6分组患者CRP及PCT水平明显增高,差异具有统计学意义(P0.05)。(3)以CPIS评分为因变量,其余指标为自变量进行分析发现,CPIS评分与PCT和CRP水平呈明显线性正相关,相关系数分别为r(PCT)=0.94,r(CRP)=0.86,P0.05。(4)对入组的187例VAP患者按照CPIS评分6分与≤6分为界限,统计不同患者6个月内的生存情况,结果发现CPIS≤6分者生存率明显高于6分者。X2=8.588,P=0.003。结论:(1)PCT、CRP、CPIS评分联合评估对早期预警VAP具有一定作用。(2)CPIS评分与VAP生存率相关联,可为VAP患者临床生存预后提供参考。
[Abstract]:Objective to investigate the clinical value of PCTU CRP and CPIS score in patients with ventilator-associated pneumonia (VAP), and to explore the correlation between serum levels of CRP and CPIS. Methods from June 2013 to June 2016, 633 EICU patients were enrolled in the first affiliated Hospital of Guangzhou Medical University, of whom 435 were required to undergo invasive mechanical ventilation. The blood levels of PCT CRP and sputum culture were collected, and the clinical pulmonary infection (CPIS) scores were evaluated. The relationship between various factors and VAP was observed, and the prognosis of the patients was analyzed. The statistical method was analyzed by SPSS 19.0, the counting data was expressed in the form of rate), the measurement data was expressed in the form of 卤s, the comparison between groups was expressed by t test, the comparison between counting data by 蠂 2 test, and the multivariate linear regression analysis by multivariate analysis. Log Rank test was used to evaluate the survival and prognosis of the patients, and p0.05 showed that the difference was statistically significant. Results among 187 patients with VAP, 103 were male and 84 were female. The age was 46 to 101 years old (mean 65 卤12.5 years). The occurrence and distribution of VAP in each group were as shown in Table 3, figure 1, figure 2 of 187 VAP patients according to sex, age and etiology of CPIS score. 2. Of 187 VAP patients with VAP, 159 cases were found to be PCT positive (i.e. 0.5ugr / L = 1677 + 89.3) and 10 mg / L were found to be positive for CRP (10 mg / L). According to the type of infection and the classification of infected bacteria, there was no significant difference in the level of CRP between the three groups (P 0.05), the CPIS score was divided into 6 points, and the levels of CRP and PCT were statistically analyzed after the VAP patients were divided into two groups, and the results showed that there was no significant difference in the levels of CRP and PCT between the two groups. The levels of CRP and PCT were significantly higher than those in subgroup 鈮，

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