联合床边早期革兰染色涂片、前降钙素对ICU呼吸机相关性肺炎患者预后的影响

Effect of early bedside Gram staining and PCT on the prognosis of patients with ventilator-associated pneumonia in ICU

目的探讨联合床边快速革兰染色涂片、前降钙素(PCT)对ICU呼吸机相关性肺炎(VAP)患者预后的影响。方法前瞻性选取80例符合VAP诊断标准的患者,根据有无进行床边早期革兰染色将患者分为两组。观察组(40例)通过支气管镜取患者病变侧肺的下呼吸道分泌物,采用早期(2 h时内)快速革兰染色涂片,根据染色结果选择针对性的抗生素;对照组(40例)经验性使用抗生素。所有患者都在使用抗生素前均院内送检标本,包括痰培养及药敏、PCT等炎症指标。统计所有患者的28 d病死率、体温下降时间、机械通气时间、ICU住院时间、PCT变化(观察第1、3、5天)等。结果(1)观察组与对照组相比,患者体温下降时间、住院时间、机械通气时间、PCT均下降明显,两者之间差异有统计学意义(P<0.05);(2)早期革兰染色涂片与送检痰培养结果符合率较高;(3)观察组与对照组相比,患者28 d病死率更低,28 d累积生存率更高,两者之间差异有统计学意义(P<0.05)。结论联合早期革兰染色涂片、PCT指导初始抗生素使用能够较经验用药改善VAP患者的预后。

Objective To investigate the effect of combined bedside fast Gram staining smear and PCT on the prognosis of patients with ventilator-associated pneumonia in ICU.Methods Eighty patients who met the VAP diagnostic criteria were prospectively selected and divided into two groups according to whether or not early Gram staining was performed.The experimental group(40 patients):Lower respiratory tract secretions from the diseased side of the lung were taken by bronchoscope,and early(within two hours)fast Gram staining smears were used to select specific antibiotics according to the results of staining.The control group(40 patients):empirical use of antibiotics.Before using antibiotics,all patients were sent to hospital for examination,including sputum culture,drug sensitivity,PCT and other inflammatory indicators.The 28-day mortality,time of hypothermia,duration of mechanical ventilation,length of stay in ICU,PCT changes(observed on the 1st,3rd and 5th days)were counted.Results 1.Compared with the control group,the time of hypothermia,hospitalization,mechanical ventilation and PCT decreased significantly in the experimental group,and there were significant differences between them(P<0.05).2.The matching rate of early Gram staining smear and sputum culture was higher.3.Compared with the control group,the 28-day mortality rate of the patients was lower and the 28-day cumulative survival rate was higher in the experimental group.Statistical difference(P<0.05).Conclusion Combining early Gram staining smear and PCT to guide the initial antibiotic use can improve the prognosis of VAP patients.