和肽素、乳酸及D-二聚体对呼吸机相关性肺炎预后评估的研究

Study the prognostic evaluation of peptide hormone,lactic acid and D-dimer in ventilator associated pneumonia

目的探讨和肽素、乳酸及D-二聚体在呼吸机相关性肺炎预后评估中的价值。方法选择2015年5月-2016年5月我院呼吸科及重症监护室ICU收治的50例慢性阻塞性肺疾病急性加重合并呼吸衰竭、脑卒中、海水淹溺需行机械通气治疗的患者,依据呼吸机相关性肺炎的诊断标准将患者分为呼吸机相关性肺炎组（VAP组）29例,非呼吸机相关性肺炎组（非VAP组）21例。根据患者预后,VAP组患者死亡10例（死亡组）,好转19例（存活组）。测定各组患者和肽素、乳酸、D-二聚体的水平,探讨三项指标与呼吸机相关性肺炎预后的关系。结果 VAP组和肽素、乳酸、D-二聚体、PCT、APACHEⅡ等指标均明显高于非VAP组（P〈0.05）;存活组和肽素、乳酸、D-二聚体、PCT、APACHEⅡ等指标均明显低于死亡组（P〈0.05）;死亡组患者和肽素、乳酸、D-二聚体敏感度略低于PCT,但均具有较高的灵敏度和特异度。结论和肽素、乳酸及D-二聚体水平是呼吸机相关性肺炎死亡的强预测因子,有助于指导临床评估患者的危险度。

Objective To explore the value of peptide hormone,lactic acid and D-dimer in prognostic evaluation of ventilator associated pneumonia.Methods 50 patients with ccute exacerbation of chronic obstructive pulmonary disease combined with respiratory failure,cerebral apoplexy and saltwater drowning that needed mechanical ventilation therapy,from May 2015 to May 2016 of respiration department and ICU of our hospital were selected.Patients were divided into ventilator associated pneumonia（VAP group,n=29） and non ventilator associated pneumonia（non VAP group,n=21） according to the diagnostic criteria of ventilator associated pneumonia.According to the prognosis of patients,the 10 death patients of VAP group were divided into death group and 19 improvement patients were divided into survival group.The level of peptide hormone,lactic acid and D-dimer in each group were tested,and the relationship between the three index and ventilator associated pneumonia was studied.Results The peptide hormone,lactic acid,D-dimer,PCT,APACHEⅡin VAP group was obvious higher than that of non VAP group respectively（P〈0.05）;The peptide hormone,lactic acid, Ddimer,PCT,APACHEⅡ in survival group was obvious lower than that of death group respectively（P〈0.05）;The susceptibility of peptide hormone,lactic acid and D-dimer in VAP was lower than PCT in death group,and all of them had higher susceptibility.Conclusion Peptide hormone,lactic acid and D-dimer are powerful predictive factor of ventilator associated pneumonia death,which is helpful to guide the clinical evaluation of the patients′risk.