血清降钙素原与临床肺部感染评分在呼吸机相关肺炎诊疗中价值

Value of serum procalcitonin and Clinical Pulmonary Infection Score to the diagnosis and treatment of ventilator-associated pneumonia

目的探讨血清降钙素原(procalcitonin,PCT)与临床肺部感染评分(Clinical Pulmonary Infection Score,CPIS)在呼吸机相关肺炎(ventilator-associated pneumonia,VAP)诊断及治疗中价值。方法行机械通气治疗患者83例,其中发生VAP者43例为观察组,未发生VAP者40例为对照组,记录2组机械通气前、机械通气48h后血清PCT水平、CPIS评分和PCT阳性率,比较应用抗生素治疗7d后好转与恶化VAP患者血清PCT、CPIS评分差异。结果观察组机械通气48h后血清PCT水平[(1.31±0.12)μg/L]、CPIS评分(7.56±2.01)、血清PCT阳性率(83.72%)均高于机械通气前[PCT(0.41±0.07)μg/L、CPIS评分(4.12±1.02)、血清PCT阳性率25.58%](P<0.05),且高于对照组机械通气治疗后[PCT(0.49±0.07)μg/L、CPIS评分(4.51±1.01)、血清PCT阳性率(30.00%)](P<0.05);应用抗生素治疗7d后,43例VAP患者中病情好转28例,病情恶化15例,病情好转者治疗后血清PCT水平[(0.43±0.02)μg/L]低于病情恶化者[(3.62±0.21)μg/L]、CPIS评分(3.67±1.44)低于病情恶化者(9.02±2.01)(P<0.05)。结论行机械通气治疗患者血清PCT、CPIS评分增高对诊断VAP有一定价值,且血清PCT、CPIS评分高者预后较差。

Objective To investigate the value of serum procalcitonin（PCT）and Clinical Pulmonary Infection Score（CPIS）to the diagnosis and treatment of ventilator-associated pneumonia（VAP）.Methods Eighty-three patients receiving mechanical ventilation were divided into observation group（n=43）with VAP,and control group（n=40）with no VAP.The serum PCT level,CPIS score and PCT positive rate were recorded before and 48 hours after ventilation.The differences of serum PCT and CPIS score were compared between the patients with relieved VAP and deteriorated VAP after 7-day antibiotic treatment.Results After mechanical ventilation for 48 hours,the serum PCT（（1.31±0.12）μg/L）,PCT positive rate（83.72%）and CPIS score（7.56±2.01）were significantly higher than those before ventilation（（0.41±0.07）μg/L,25.58%,4.12±1.02）in observation group（P0.05）,and higher than those in control group after ventilation（（0.49±0.07）μg/L,30.00%,4.51±1.01）（P0.05）.After antibiotic treatment for 7days,in 43 patients with VAP,28 were relieved and 15 got deterioration.The PCT and CPIS were（0.43±0.02）μg/L and 3.67±1.44 in the patients with relieved VAP,significantly lower than those in the patients with deteriorated VAP（（3.62±0.21）μg/L,9.02±2.01）（P0.05）.Conclusion High levels of serum PCT and CPIS score have values to the diagnosis of VAP,and high levels of PCT and CPIS indicate a poor prognosis.