动态监测临床肺部感染评分在急性呼吸窘迫综合征患者病情及预后评估中的意义

Assessment of condition and prognosis of acute respiratory distress syndrome by ambulatory monitoring of clinical pulmonary infection score

目的研究临床肺部感染评分(Clinical pulmonary infection score,CPIS)对急性呼吸窘迫综合征(Acute respiratorydistresssyndrome,ARDS)患者病情严重程度和预后的判断价值。方法对2009年1月至2011年5月入住急诊重症监护室(EICU)的42例ARDS患者,动态连续监测血气分析、血常规、血生化、胸部影像学检查、下呼吸道分泌物检查,评价心、脑、肝、肾、肠道等多器官功能状态,按照预后分生存组和死亡组,对确诊后第1、3、5、7天的CPIS分值进行对比分析。结果两组第1、3天的CPIS分值比较,差异无统计学意义(P>0.05),而第5、7天的CPIS分值死亡组均显著高于生存组,多器官功能障碍综合征(Multiple organ dysfunction syndrome,MODS)和(或)多器官功能衰竭(Multiple organ failure,MOF)发生率更高,差异均有统计学意义(P<0.05);总住院时间生存组显著高于死亡组,两组ICU治疗时间差异无统计学意义(P>0.05)。结论 CPIS动态变化能反应患者病情变化,并辅助判断患者预后,可作为初步评估ARDS病情及预后的简易指标之一。

Objective To investigate the diagnostic value of clinical pulmonary infection score （CPIS） in assessing the condition and prognosis of acute respiratory distress syndrome （ARDS）. Methods Forty-two cases of ARDS admitted to emergency intensive care unit （EICU） between Jan 2009 and Mar 2011 underwent continues monitoring of blood gas, blood routine examination, blood biochemistry examination, chest X-ray or CT, and lower respiratory tract secretion examination. Functions of heart, brain, liver, kidney, gastrointestinal tract were evaluated. The patients were assigned to survival group and death group according to the prognosis. CP1S 1,3,5,7 day after diagnosis of the two groups were analyzed. Results No significant differences were found in CPIS of both groups on the first and the third day （ P 〉 0.05 ）. CPIS on the fifth and the seventh day in death group were significantly higher than those in survival group （P 〈 0. 05 ）. The incidence of multiple organ dysfunction syndrome （MODS） or multiple organ failure （MOF） in death group was significantly higher than that of survival group （P 〈 0.05 ）. The total length of stay in death group was longer than that in survival group. There was no significant difference between the two groups in time of therapy in ICU. Conclusion The dynamic change of CPIS can be used as a simple indicator for evaluating the condition and prognosis of ARDS.