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目的探讨血清降钙素原(procalcitonin,PCT)与临床肺部感染评分(Clinical Pulmonary Infection Score,CPIS)在呼吸机相关肺炎(ventilator-associated pneumonia,VAP)诊断及治疗中价值。方法行机械通气治疗患者83例,其中发生VAP者43例为观察组,未发生VAP者40例为对照组,记录2组机械通气前、机械通气48h后血清PCT水平、CPIS评分和PCT阳性率,比较应用抗生素治疗7d后好转与恶化VAP患者血清PCT、CPIS评分差异。结果观察组机械通气48h后血清PCT水平[(1.31±0.12)μg/L]、CPIS评分(7.56±2.01)、血清PCT阳性率(83.72%)均高于机械通气前[PCT(0.41±0.07)μg/L、CPIS评分(4.12±1.02)、血清PCT阳性率25.58%](P<0.05),且高于对照组机械通气治疗后[PCT(0.49±0.07)μg/L、CPIS评分(4.51±1.01)、血清PCT阳性率(30.00%)](P<0.05);应用抗生素治疗7d后,43例VAP患者中病情好转28例,病情恶化15例,病情好转者治疗后血清PCT水平[(0.43±0.02)μg/L]低于病情恶化者[(3.62±0.21)μg/L]、CPIS评分(3.67±1.44)低于病情恶化者(9.02±2.01)(P<0.05)。结论行机械通气治疗患者血清PCT、CPIS评分增高对诊断VAP有一定价值,且血清PCT、CPIS评分高者预后较差。
Objective To investigate the value of serum procalcitonin (PCT) and Clinical Pulmonary Infection Score (CPIS) in the diagnosis and treatment of ventilator-associated pneumonia (VAP). Methods 83 cases were treated with mechanical ventilation, in which 43 cases of VAP occurred as observation group and 40 cases of no VAP as control group.The serum PCT level, CPIS score and PCT positive rate were recorded before mechanical ventilation and 48 hours after mechanical ventilation , Comparing the differences of serum PCT and CPIS scores between patients with VAP and patients with worsening and worsening after 7 days of antibiotic treatment. Results The level of serum PCT (1.31 ± 0.12 μg / L), the CPIS score (7.56 ± 2.01) and the serum PCT positive rate (83.72%) in the observation group after mechanical ventilation for 48 hours were significantly higher than those before the mechanical ventilation [PCT (0.41 ± 0.07) (P <0.05), and higher than that of the control group [PCT (0.49 ± 0.07) μg / L, CPIS score (4.41 ± 1.02 μg / L, CPIS score 4.12 ± 1.02 and serum PCT positive rate 25.58% (P <0.05). After antibiotic treatment for 7 days, 28 cases were improved in 43 VAP patients and 15 cases were deteriorated. Serum PCT levels in patients with improved condition [(0.43 ± 0.02) μg / L] was lower than that of patients with disease progression [(3.62 ± 0.21) μg / L], and CPIS score was 3.67 ± 1.44 (9.02 ± 2.01) (P <0.05). Conclusions The serum PCT and CPIS scores in patients undergoing mechanical ventilation are of some value in the diagnosis of VAP. The high serum PCT and CPIS scores are associated with poor prognosis.