COPD合并VAP患者的微生物学特征及CPIS SOFA评分的预测价值

Microbiological cCharacteristics and pPredictive vValue of CPIS and SOFA sScores in COPD pPatients with VAP

目的:探讨慢性阻塞性肺疾病(COPD)合并呼吸机相关性肺炎(VAP)患者的微生物学特征及临床肺部感染评分(CPIS)、序贯器官衰竭评分(SOFA)评分的预测价值。方法:选取我院2019年11月至2021年11月收治的136例COPD患者,按照患者是否合并VAP将其分为研究组60例,参照组76例,另选同期50例健康体检者为对照组。对比3组基线特征及不同预后患者CPIS、SOFA评分,分析与VAP相关病原体耐药性、COPD合并VAP及预后不良的多因素;分析CPIS、SOFA及联合评分对COPD合并VAP预后的预测价值。结果:研究组有糖尿病、肺结核、因COPD多次住院、3个月内使用过抗生素占比高于参照组,CPIS、SOFA评分高于参照组,是COPD合并VAP的危险因素(P<0.05);肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌对亚胺培南、亚胺培南的耐药率低于10%,耐药率低;预后不良组CPIS、SOFA评分显著高于预后良好组(P<0.05);CPIS、SOFA评分是COPD合并VAP预后不良的危险因素(P<0.05);CPIS联合SOFA评分预测COPD合并VAP预后的AUC高于CPIS、SOFA评分AUC(P<0.05)。结论:CPIS、SOFA评分升高是COPD合并VAP的危险因素和预后危险因素,VAP抗菌治疗应根据药敏结果用药,联合评估有利于患者预后判断。

Objective:To investigate the microbiological characteristics and the predictive value of Clinical Pulmonary Infection Score(CPIS)and Sequential Organ Failure Score(SOFA)in patients with chronic obstructive pulmonary disease(COPD)complicated by ventilator-associated pneumonia(VAP).Methods:A total of 136 COPD patients admitted to our hospital from November 2019 to November 2021 were selected and divided into study group(n=60)and reference group(n=76)according to whether the patients had VAP or not,and 50 healthy subjects during the same period were selected as the control group.The baseline characteristics and CPIS and SOFA scores of the three groups of patients with different prognosis were compared,and the multi-factors associated with VAP-related pathogen resistance,COPD combined with VAP and poor prognosis were analyzed;the predictive value of CPIS,SOFA and combined scores on the prognosis of COPD combined with VAP was analyzed.Results:Diabetes,pulmonary tuberculosis,multiple hospitalizations due to COPD,and antibiotic use within 3 months in the study group were higher than those in the reference group,and the CPIS and SOFA scores were higher than those in the reference group,which were risk factors for COPD complicated with VAP(P<0.05);the resistance rate of Klebsiella pneumoniae,Pseudomonas aeruginosa,and Acinetobacter baumannii to imipenem and imipenem was less than 10%,and the drug resistance rate was low;the CPIS and SOFA scores in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05);CPIS and SOFA scores were risk factors for poor prognosis of COPD combined with VAP(P<0.05);the AUC of CPIS combined with SOFA score in predicting the prognosis of COPD combined with VAP was higher than that of CPIS and SOFA score(P<0.05).Conclusion:Elevated CPIS and SOFA scores are risk factors and prognostic risk factors for COPD complicated with VAP.VAP antimicrobial therapy should be administered according to the drug sensitivity results,and combined evaluation is beneficial to the prognosis of patients.