摘要
目的探讨临床肺部感染评分(CPIS)对早期呼吸机相关肺炎(VAP)患者治疗反应及预后的评价。方法对2002年1月至2005年12月入住呼吸重症监护室且资料完整的62例VAP患者,在出现呼吸机相关肺炎前3d及患病后第1、3、5、7天的CPIS分值进行分析。结果患病后第1天(7.2±1.5)、第3天(7.3±1.3)、第5天(7.0±2.1)和第7天(5.8±3.5)与患病前3d(3.3±1.1)的评分比较明显升高;死亡组患病后第1天(7.4±1.8)、第3天(7.7±1.5)、第5天(8.5±1.4)和第7天(8.9±1.4)与患病前3d(3.6±1.1)的评分比较明显升高;存活组患病后第1天(6.9±1.0)、第3天(6.9±1.1)、第5天(5.5±1.6)与患病前3d(3.1±1.1)的评分比较升高,第7天(2.7±1.8)显著下降。患病第5天CPIS>6分时,与存活患者相比病死率增高,其敏感性和特异性分别为96.8%和74.2%;CPIS分值与机械通气时间、住呼吸重症监护室时间和住院时间呈正相关(r值分别为0.526、0.449、0.519,P=0.00)。当接受充分治疗后,患病第5天CPIS轻度下降,而在没有充分的抗菌治疗时变化不明显。结论CPIS监测可早期预测VAP患者的病情、治疗效果及预后。
Objective To prospectively evaluate the performance of the clinical pulmonary infection score （CPIS） and its prognostic value for early onset ventilator-associated pneumonia （VAP）. Methods The clinical data of 62 cases with VAP in the respiratory intensive care unit （RICU） were studied. The CPIS score was calculated at 3 days before the onset of VAP （ VAP - 3 ）, at the onset of VAP（ VAP ＋ 1 ）, and at 3 （ VAP ＋ 3 ） , 5 （ VAP ＋ 5 ） , and 7 （ VAP ＋ 7 ） days after onset, and the pathogens were examined. Results A significant higher CPIS score was found at the onset of VAP （ YAP ＋ 1 ） 7.2 ± 1.5, and at 3 （ VAP ＋ 3 ） 7.3 ± 1.3, 5 （ VAP ＋ 5 ） 7.0 ± 2. 1, and 7 （ VAP ± 7 ） 5. 8 ± 3. 5 days after onset compared with at 3 days before YAP（ VAP - 3 ） 3.3 ± 1.1 （ P 〈 0. 01 ）. An increase of CPIS was significant in nonsurvivors at the onset of VAP（VAP ＋ 1）7.4 ± 1.8,and at 3（VAP＋3）7. 7 ± 1.5, 5（VAP＋5）8. 5 ± 1.4, andT（VAP ＋7） 8. 9 ± 1.4 days after onset compared with at 3 days before VAP（ VAP - 3 ） （ 3.6 ± 1.1 ） （ P 〈 0.01 ）. An increase in CPIS was also significant in survivors at the onset of VAP（ VAP ＋ 1 ） 6. 9 ±1.0, at 3 （ VAP ＋ 3 ） 6.9 ± 1.1, and 5 （ VAP ＋ 5 ） 5.5 ± 1.6 day after onset compared with at 3 days before VAP （ VAP - 3 ） 3.1 ± 1.1 （P 〈 0. 01 ）, but the decrease in CPIS was significant at 7 （ VAP ＋ 7 ） 2. 7 ±1.8 day after VAP onset （ P 〈 0. 01 ） . In patients with a CPIS 〉 6 at 5 clays after VAP onset, the mortality was higher than those with a CPIS 〈 6 （ P = 0. 00 ）. The sensitivity and specificity of predicted mortality was 96. 8 percent and 74. 2 percent respectively. There was a significant correlation between CPIS score and length of mechanical ventilation （ r = 0. 526, P = 0.00） and length of respiratory intensive care unit stay （ r = 0. 449, P = 0.00 ） and the length of hospital stay （r =0. 519,P =0. 00）. Patients receiving adequate therapy showed a slight fall in CPIS at VAP ＋ 5,whereas those with inadequate therapy did not. Condusion Serial measurement of CPIS is valuable in predicting the severity of illness and evaluating the effect of therapy and prognosis.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2006年第11期751-754,共4页
Chinese Journal of Tuberculosis and Respiratory Diseases
关键词
肺炎
临床肺部感染评分
Pneumonia
Clinical pulmonary infection score
