不同撤机策略致呼吸机相关性肺炎患者血清PCT和CRP水平变化的临床意义

目的探讨不同撤机策略致呼吸机相关性肺炎患者血清PCT和CRP水平变化的临床意义。方法收集2012年1月至2014年12月采用呼吸机进行机械通气治疗撤机后引起呼吸机相关性肺炎（VAP）患者162例，并依据撤机策略引起的VAP分为经验型VAP、计划型VAP和智能型VAP，并对进行APACHEⅡ评分、简化的临床肺部感染评分（CPIS）、全身性感染相关性器官功能障碍评分（SOFA）和痰培养，以及检测氧合指数、血清IL-6、IL-8、PCT和CRP水平进行比较。结果氧合指数在不同患者组别中差异有统计学意义（P〈0．01）。经验型VAP患者病死率高于计划型和智能型VAP（P〈0．05）。不同撤机策略并发的VAP病情程度不一致（P〈0．01），由经验型撤机方式引起的VAP患者APACHEII、CPIS、SOFA评分最高。血清IL-6、IL-8、PCT、CRP浓度在由不同撤机方式引起的VAP患者中差异均有统计学意义（P〈0．01）；经验型撤机引起的VAP患者PCT的OR值最大4．586（P〈0．01），其次是计划型撤机引起的VAP其PCT的OR值为2．810（P〈0．01），CRP在经验型撤机和计划性撤机引起的VAP中的OR值均〉1（P〈0．0001），但高于IL．6的OR值（1．082和1．275）。结论对机械通气的患者撤机时应尽可能采用计划性和智能软件控制的撤机模式，检测血清PCT和CRP水平对撤机致VAP患者病情预后有一定帮助。

Objective To explore the clinical value of serum PCT and CRP levels in the patients with ventilator-associated pneumonia （ VAP ） induced by different ventilator weaning strategies. Methods 162 cases with VAP induced by different ventilator weaning strategies in intensive care unit of First Affiliated Hospital of Guangzhou medical university from January 2012 to December 2014 were collected, and divided into three groups according to the strategies. They were VAP group induced by experienced weaning, planned weaning, and software regulated weaning, respectively. APACHEII score, simplified clinical pulmonary infection score （ CPIS ） , systemic infection organ function-associated score （ SOFA ） , and sputum culture were performed, in addition, oxygenation index and serum IL-6, IL-8, PCT and CRP levels were also detected. Results A significant difference of oxygenation index between the VAP patients with different weaning strategies existed （P〈0.0001） . The death rate of the VAP patients induced by experienced weaning was higher than that of the VAP induced by planned weaning and software regulated weaning （ P〈0.05 ） . Different illness degree appeared in the VAP patients with varied weaning strategies （P〈0.0001） , and the APACHEII, CPIS, SOFA score in the experienced weaning of VAP patients were the highest. There were significant differences of serum IL-6, IL-8, PCT and CRP levels in the VAP patients with varied weaning （ P〈0.0001 ） . The odds rate （ OR ） value of PCT in the experienced VAP patients was the highest （ 4.586, P〈0.0001 ） , the next was that of the planned weaning VAP patients （ 2.810, P〈0.0001 ） . As for the CRP, its OR value in the VAP patients induced by experienced weaning and planned weaning was more than 1 and that of IL-6 （ 1.082 and 1.275 ） . Conclusion Planned and software regulated weaning strategies make for the ventilator patients required for weaning, and the serum PCT and CRP levels provide some useful value for the VAP patients resulted from weaning in assessment of prognosis.