呼吸机相关性肺炎的评分与预后的临床意义

Clinical significance of ventilator-associated pneumonia score and impact of infection on prognosis

目的对行机械通气患者肺部感染病原菌分布进行分析,探讨肺部感染评分(CPIS)的临床意义及感染对呼吸机相关性肺炎(VAP)预后的影响,以期为临床诊疗提供参考。方法回顾性分析2012年1月-2015年1月在医院接受机械通气治疗的80例VAP患者的临床资料,作为感染组,同时将接受机械通气未并发VAP的150例患者作为未感染组,医院同期100名健康体检者作为对照组;采用法国生物梅里埃微生物全自动鉴定仪进行病原菌鉴定分型,比较感染组与未感染组住院期间临床肺部感染评分(CPIS)和累积病死率。结果感染组患者送检标本中共分离出病原菌80株,其中革兰阴性菌42株占52.5%、革兰阳性菌31株占38.75%,真菌7株占8.75%;感染组患者FEV1、FVC、FEV1/FVC及FEV1%显著低于未感染组和对照组,差异均有统计学意义(P<0.05);感染组患者PaO2及IL-10水平显著降低,而IL-6及PaCO2水平显著升高,与未感染组和对照组相比差异均有统计学意义(P<0.05);感染组患者住院期间累积病死率(31.25%)显著高于未感染组(14.00%),差异有统计学意义(P<0.01);感染组死亡患者CPIS显著高于存活患者,差异有统计学意义(P<0.01)。结论感染可导致VAP患者肺功能下降,病死率显著增加,CPIS分值高提示此类患者预后不良。

OBJECTIVE To analyze the distribution of pathogens causing pulmonary infections in mechanical ventilation patients,explore the clinical significance of clinical pulmonary infection score（CPIS）,and observe the impact of infection on prognosis of ventilator-associated pneumonia（VAP）so as to provide guidance for clinical diagnosis and treatment.METHODS The clinical data of 80 VAP patients who received the mechanical ventilation from Jan2012 to Jan 2015 were retrospectively analyzed,meanwhile,150 patients who received the mechanical ventilation but were not complicated with VAP were assigned as the non-infection group,and 100 healthy people who received physical examination were set as the control group.The pathogens were identified by using automatic microorganism identification system of BioMérieux,France,and the CPIS and cumulative fatality rate were compared between the infection group and the non-infection group during the hospital stay.RESULTS A total of 80 strains of pathogens were isolated from the submitted specimens that were obtained from the patients in the infection group,including 42（52.5%）strains of gram-negative bacteria,31（38.75%）strains of gram-positive bacteria,and 7（8.75%）strains of fungi.The FEV1,FVC,FEV1/FVC,and FEV1% were significantly lower in the infection group than in the non-infection group and the control group（P〈0.05）.The levels of PaO2 and IL-10 of the infection group were significantly reduced,however,the levels of IL-6and PaCO2 were significently elevated,as compared with the non-infection group and the control group（P〈0.05）.The cumulative fatality rate of the infection group was 31.25% during the hospital stay,significantly higher than 14.00% of the non-infection group（P〈0.01）.Among the patients with infections,the CPIS of the patients who died was significantly higher than that of the patients who survived（P〈0.01）.CONCLUSIONThe infections may result in the decline of lung function of the VAP patients,the fatality rate is remarkably increased,and the high CPIS indicates that such patients have poor prognosis.