目的 评价胸部超声降钙素肺部感染评分法(chest echography and procalcitonin pulmonary infection score,CEPPIS)对呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的诊断价值。方法 回顾性分析陆军特色医学中心ICU 收治的符合纳入标准的机械通气患者。按照支气管微生物学培养结果分为微生物学确诊VAP组和对照组,统计两组在ICU住院期间的感染症状、痰液涂片、培养检查、降钙素原、血常规检查,胸部超声及胸部X线片检查结果,记录预后指标。以痰液培养微生物结果作为诊断VAP的金标准,采用ROC曲线分析评估CPIS评分表、CEPPIS评分与降钙素原(procalcitonin,PCT)诊断VAP的效能。结果 总共144例患者纳入研究,平均(54.35±21.49)岁。微生物确诊VAP组71例,对照组73例。CEPPIS＞5诊断VAP的ROC面积为0.846(95% CI:0.775~0.916,P=0.001)大于CPIS＞6 ROC面积[0.713(95% CI:0.625~0.800,P=0.001)]和降钙素原(procalcitonin,PCT)＞1 ng/ml ROC面积[0.557(95% CI:0.463~0.652,P=0.048)]。结论 CEPPIS诊断VAP的效能可能好于CPIS和PCT,需要进一步评估其诊断价值。
Abstract
Objective To evaluate the diagnostic performance of the chest echography and procalcitonin pulmonary infection score(CEPPIS) of patients with ventilator-associated pneumonia(VAP).Methods Patients who were on mechanical ventilation in the intensive care unit (ICU) of Army Medical Center and met the inclusion criteria were included in this study. These patients were divided into the VAP group and control group according to the culture results of bronchial microorganisms (with nosocomial infection and total bacterial colonies>105/ml). Demographic information, clinical features and prognosis were compared via statistical analysis. The CEPPIS and clinical pulmonary infection score(CPIS) were graded using indicators including pulmonary echography, bedside chest radiography, procalcitonin and sputum culture when patients experienced dyspnea or decreased oxygenation. A receiver operating characteristic (ROC) analysis was conducted of CEPPIS, CPIS and procalcitonin to evaluate their diagnostic performance.Results A total of 144 patients were included with 71 patients in the VAP group and 73 in the control group. 93(64.6%) of them were males, and the average age was 54.35 years with a standard deviation of 21.49. The area under curve(AUC) of CEPPIS>5 was 0.846(95%CI:0.775-0.916,P<0.01), greater than 0.713 of CPIS>6 (95%CI:0.625-0.800, P<0.01) and 0.557 of PCT>1 ng/ml(95% CI:0.463-0.652,P=0.048).Conclusions The diagnostic performance of CEPPIS is possibly better than that of CPIS and PCT, but more research is needed to investigate its diagnostic efficiency.
关键词
呼吸机相关性肺炎 /
超声 /
降钙素 /
感染评分 /
诊断效能
Key words
ventilator-associated pneumonia /
echography /
procalcitonin /
scores /
diagnostic performance
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基金
重庆市技术创新与应用发展专项面上项目(stc2019jscx-msxmx0240;stc2019jscx-msxmx0266)
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