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目的研究创伤后蛋白C(PC)水平的早期减少是否会使创伤患者患呼吸机相关性肺炎(VAP)的风险增加。方法收集87例确诊入住ICU行气管插管创伤患者的临床资料,按诊断标准分为VAP组和非呼吸机相关性肺炎(NVAP)组,对两组患者的相关临床资料、PC及可溶性内皮细胞蛋白C受体(sEPCR)水平进行比较。结果与非呼吸机相关性肺炎患者比较,呼吸机相关性肺炎患者机械通气天数(4.4±0.5)d与(16.3±1.8)d,差异有统计学意义(P<0.01),住院天数(13.9±1.9)d与(28.7±2.3)d,差异有统计学意义(P<0.05),入住ICU时间(5.6±0.7)d与(17.1±1.2)d,差异有统计学意义(P<0.01);病死率7.9%与29.2%,VAP患死亡率明显升高;与NVAP患者比较,VAP患者12、24 h PC水平均明显降低,为(98.3±9.6)%与(75.8±6.8)%、(95.4±12.9)%与(69.1±7.3)%,均P<0.05;与NVAP患者比较,VAP患者6 h sEPCR水平明显升高,为(207.1±27.9)ng/ml与(241.5±19.8)ng/ml,P<0.05。结论创伤后蛋白C水平的早期减少会使呼吸机相关性肺炎的风险增加,而蛋白C水平的减少可能与可溶性内皮细胞蛋白C受体的升高有关。
Objectives To investigate whether an early reduction in traumatic protein C (PC) levels may increase the risk of traumatic patients suffering from ventilator-associated pneumonia (VAP). Methods The clinical data of 87 patients admitted to the ICU with tracheal intubation trauma were collected and divided into VAP group and non-ventilator-associated pneumonia group according to the diagnostic criteria. The clinical data, PC and soluble endothelial cells Protein C receptor (sEPCR) levels were compared. Results Compared with non-ventilator-associated pneumonia patients, the days of mechanical ventilation (4.4 ± 0.5) days and (16.3 ± 1.8) days in ventilator-associated pneumonia patients were statistically significant (P <0.01) (P <0.05). There were significant differences between the two groups in the duration of ICU stay (5.6 ± 0.7) days and (17.1 ± 1.2 days) (P <0.01). The mortality rate of VAP patients was significantly higher than that of NVAP patients (7.9% vs 29.2%, P <0.05). The PC level in VAP patients at 12 and 24 hours were significantly lower than that of patients with NVAP (98.3 ± 9.6% vs 75.8 ± 6.8%, 95.4% ± 12.9% and 69.1 ± 7.3% respectively, all P <0.05. Compared with NVAP patients, the levels of sEPCR at 6 h in VAP patients were significantly higher (207.1 ± 27.9) ng / ml and (241.5 ± 19.8) ng / ml , P <0.05. Conclusion The early reduction of protein C level after trauma may increase the risk of ventilator-associated pneumonia. The decrease of protein C may be related to the increase of protein C receptor in soluble endothelial cells.