改良临床肺部感染评分在呼吸机相关性肺炎疗效评估中的应用

Application of improving clinical pulmonary infection score in evaluation of therapeutic effect of ventilator-associated pneumonia

目的探讨改良临床肺部感染评分(CEPPIS)在呼吸机相关性肺炎(VAP)疗效评估中的应用。方法入选2016年1月至2019年3月徐州医科大学附属医院急诊ICU病区内呼吸机相关性肺炎患者66例,分为显效组和无效组。记录两组患者诊断VAP第1天和第5天的CEPPIS、肺部超声评分(LUS)、临床肺部感染评分(CPIS)、降钙素原(PCT)。比较两组患者CEPPIS、LUS、CPIS、PCT的变化趋势。结果诊断VAP第1天:两组CEPPIS、LUS、CPIS、PCT比较差异均无统计学意义(P>0.05)。诊断VAP第5天:无效组的CEPPIS(t=9.666,P<0.05)、LUS(t=7.015,P<0.05)、CPIS(t=6.635,P<0.05)、PCT(t=2.727,P<0.05)大于显效组,差异有统计学意义。显效组:CEPPIS、LUS、CPIS第5天下降;无效组:CEPPIS、LUS第5天升高。CEPPIS(rs=-0.761)、LUS(rs=-0.668)、CPIS(rs=-0.648)、PCT(rs=-0.259)与疗效之间存在负相关,CEPPIS相较于LUS、CPIS、PCT与疗效存在较高的相关关系。结论CEPPIS纳入了新的指标和方法,辅助用于评估VAP疗效是可行的。

Objective This study is exploring the application of improving clinical pulmonary infection score in the evaluation of the efficacy of ventilator-associated pneumonia.Methods From January 2016 to March2019,66 patients with ventilator-associated pneumonia who were in the icu emergency department of The Affiliated Hospital of Xuzhou Medical University were divided into effective group and ineffective group.When the patients were diagnosed with VAP,CEPPIS,LUS,CPIS,PCT were recorded on the first and fifth day.Comparing the change trend of CEPPIS,LUS,CPIS and PCT between the two groups.Results The first day:there was no significant difference in CEPPIS,LUS,CPIS and PCT between the two groups(P>0.05).On the 5 th day:CEPPIS(t=9.666,P<0.05),LUS(t=7.015,P<0.05),CPIS(t=6.635,P<0.05),PCT(t=2.727,P<0.05)in the ineffective group were higher than those in the effective group.The difference was statistically significant.In the effective group,CEPPIS,LUS and CPIS decreased on the 5 th day.In the ineffective group,CEPPIS and LUS increased on the 5 th day.CEPPIS(rs=-0.761),LUS(rs=-0.668),CPIS(rs=-0.648),PCT(rs=-0.259)had a negative correlation with the efficacy,and CEPPIS had a higher correlation with the efficacy than LUS,CPIS,PCT.Conclusions The improved clinical pulmonary infection score(CEPPIS)has incorporated new indicators and methods,and it is feasible to assist in the evaluation of VAP efficacy.