四种评分系统对呼吸机相关性肺炎的预后评估研究

Research of prognosis assessment by four kinds of scoring systems in the patients of ventilatorassociated pneumonia

目的 探讨急性生理学和慢性健康评分（APACHEⅡ）、序贯器官衰竭评估（SOFA）评分、临床肺部感染评分（CPIS）及多器官功能障碍综合征（MODS）评分对呼吸机相关性肺炎（VAP）患者的预后评估价值.方法 68例诊断为VAP患者,分别在入院第一个24 h进行APACHEⅡ、SOFA评分、MODS评分及发生VAP第一个24 h进行APACHEⅡ、SOFA评分、CPIS及MODS评分.根据实际预后分为存活组38例和死亡组30例,并根据受试者工作特征曲线下面积（AUROC）与Logistic回归分析评估四种评分系统对VAP患者预后的预测价值.结果 死亡组发生VAP第一个24 h的APACHEⅡ、CPIS、MODS评分及SOFA评分均明显高于存活组.发生VAP第一个24 h的APACHEⅡ、SOFA评分、MODS评分及CPIS AUROC分别为0.80、0.75、0.73、0.71.Logistic回归分析提示发生VAP第一个24 h的APACHEⅡ＞18分是预测VAP患者的独立相关因素（OR值为5.7,95%CI为1.9～20.0,P值为0.013）.结论 发生VAP第一个24 h的APACHEⅡ评分可作为预测VAP患者预后的指标.

Objective To study the significance of the prognosis assessment by acute physiology and chronic health evaluation （APACHE Ⅱ ）,sequential organ failure assessment （SOFA） score,clinical pulmonary infection score（CPIS） and multiple organ dysfunction syndrome （MODS） score in the patients of ventilator-associated pneumonia （VAP）. Methods The clinical data of 68 cases with VAP in the ICU or RICU were studied. APACHE Ⅱ , SOFA and MODS scores on admission and APACHE Ⅱ , SOFA, CPIS and MODS scores on the first 24-hour of VAP diagnosis were recorded. The area under the receiver operating characteristic curve（AUROC ） and Logistic regression were used to estimate the prognostic ability by the four kinds of scoring systems. Results The APACHE Ⅱ , CPIS, MODS and SOFA scores on the first 24-hour of VAP diagnosis were significantly higher in non-survivors than those in survivors. AUROC of APACHE Ⅱ ,SOFA,MODS and CPIS respectively were 0.80,0.75,0.73,0.71. Logistic regression analysis showed that only APACHE Ⅱ〉 18 scores on the first 24-hour of VAP diagnosis was an independent predictor of the mortality （OR： 5.7,95% CI： 1.9 - 20.0, P = 0.013）. Conclusion The APACHE Ⅱ on the first 24-hour of VAP diagnosis may be a useful index in predicting progress of patients with VAP.