肺结核合并 VAP 患者动态观察 CPIS 的变化及其意义

Changes and significance of clinical pulmonary infection score in patients with pulmonary tuberculosis complicated with ventilator associated pneumonia

目的：探讨临床肺部感染评分（CPIS）在肺结核并发呼吸机相关性肺炎（VAP）患者中的动态变化及其临床意义。方法选取2013年1月至2015年12月收治90例肺结核并进行机械通气治疗的患者进行回顾性分析,根据最终纤维支气管镜、BALF 及血培养结果确诊 VAP 患者47例（VAP 组）、非 VAP 患者43例（非 VAP 组）,对比两组患者的 CPIS 评分变化趋势,并根据治疗结局将 VAP 患者分为存活组和死亡组进行亚组分析。结果气管插管时,VAP 组和非 VAP 组患者的CPIS 评分差异无统计学意义（P 〉0.05）；在机械通气第3天、第7天、第14天,VAP 组患者 CPIS评分均显著的高于非 VAP 组患者（P 〈0.05）；VAP 组机械通气治疗时间、RICU 治疗时间、住院时间、病死率均显著的高于非 VAP 组患者,差异有统计学意义（P 〈0.05）；VAP 组存活28例患者、死亡19例患者,VAP 患者中存活患者在机械通气第3天、第7天、第14天 CPIS 评分均显著的低于死亡组患者（P 〈0.05）。结论肺结核并发 VAP 患者的 CPIS 评分较非 VAP 患者呈显著的升高趋势,死亡 VAP 患者的 CPIS 评分显著的高于存活 VAP 患者,CPIS 评分在诊断 VAP 及评估患者预后中具有一定的意义。

Objective To investigate the dynamic changes and clinical significance of clinical pulmonary infection score （CPIS） in patients with pulmonary tuberculosis complicated with ventilator associated pneumonia（VAP）.Methods From January 2013 to December 201 5 90 cases of tuberculosis in patients treated with mechanical ventilation were retrospectively analyzed,according to the final bronchoscopy,bronchoalveolar lavage fluid and school culture results of 47 patients diagnosed with VAP （VAP group）,43 patients with non-VAP （non-VAP group）,CPIS score trends compared two groups of patients,and the VAP patients were divided into survival group and death group,subgroup analyzes based on treatment outcome.Results Intubation,CPIS score between VAP group and non-VAP group were not statistically significant（P 〉0.05）;Mechanical ventilation section 3 d,paragraph 7 d,Section 14 d,CPIS scores of VAP patients were significantly higher than that in the non-VAP patients （P 〈0.05）;VAP group mechanical ventilation time,RICU treatment time,hospital stay,mortality rates were significantly higher than those of non-VAP patients,the difference was statistically significant （P 〈 0.05）;VAP group survived 28 cases patients,1 9 patients died,VAP in patients mechanically ventilated patients survive the first 3 d,paragraph 7 d,section 14 d CPIS scores were significantly lower than the death group patients （ P 〈0.05）.Conclusions Concurrent tuberculosis patients with VAP CPIS scores than non-VAP patients shows a significant increasing trend,VAP patients died of CPIS score is significantly higher than the survival of patients with VAP,CPIS score has a certain significance in the diagnosis and prognosis of patients with VAP.