·论著·

    作者单位: 100034北京大学第一医院呼吸科 [杨国辉 (现在贵阳

    医学院附属医院呼吸科)、 王广发 ]

    通讯作者:王广发

    临床肺部感染评分对呼吸机相关肺炎患者

    预后的评价

    杨国辉 王广发

    【摘要 】 目的 探讨临床肺部感染评分 (CP IS)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 3 d及患病后第 1、 3、 5、 7天的 CP IS分值进行分析。结果 患病后第 1

    天 (712 ± 115)、 第 3天 (713 ± 113)、 第 5天 (710 ± 211)和第 7天 (518 ± 315)与患病前 3 d (313 ± 111)

    的评分比较明显升高;死亡组患病后第 1天 (714 ± 118)、 第 3天 (717 ± 115)、 第 5天 (815 ± 114)和第

    7天 (819 ± 114)与患病前 3 d (316 ± 111)的评分比较明显升高;存活组患病后第 1天 (619 ± 110)、 第

    3天 (619 ± 111)、 第 5天 (515 ± 116)与患病前 3 d (311 ± 111)的评分比较升高 ,第 7天 (217 ± 118)显

    著下降。患病第 5天 CP IS > 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 9618%和

    7412%; CP IS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 01526、01449、 01519, P = 0100)。当接受充分治疗后 ,患病第 5天 CP IS轻度下降 ,而在没有充分的抗菌治疗

    时变化不明显。结论 CP IS监测可早期预测 VAP患者的病情、 治疗效果及预后。

    【关键词 】 肺炎; 临床肺部感染评分

    Va lue of the cl i n i ca l pulmonary i nfecti on score for the prognosis of ven til a tor2 a ssoc i a ted pneumon i a

    YANG Guo2 hui , WANG Guang2 fa1 Depart m ent of Respiratory M edicine, Pek ing Univer sity Fir st Hospital ,B eijing 100034, China

    Corresponding author : WANG Guang2 fa

    【Abstract】 Objecti ve To p r os pectively evaluate the performance of the clinical pul monary infecti on

    score (CP IS ) and its p r ognostic value for early onset ventilat or2 associated pneumonia (VAP) . Methods

    The clinical data of 62 caseswith VAP in the resp irat ory intensive care unit (R I CU) were studied1 The CP IS

    score was calculated at 3 days before the onset ofVAP (VAP - 3) , at the onset ofVAP (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 CP IS score was found at the onset of VAP (VAP + 1) 712 ±115, and at 3 (VAP + 3)

    713 ± 113, 5 (VAP + 5) 710 ± 211, and 7 (VAP + 7) 518 ±315 days after onset compared with at 3 days

    before VAP (VAP - 3) 313 ±111 ( P < 0101) 1 An increase of CP IS was significant in nonsurvivors at the

    onset ofVAP (VAP + 1) 714 ± 118, and at 3 (VAP + 3) 717 ± 115, 5 (VAP + 5) 815 ± 114, and 7 (VAP + 7)

    819 ± 114 days after onset compared with at 3 days before VAP (VAP - 3) ( 316 ±111) ( P < 0101) 1 An

    increase in CP IS was also significant in survivors at the onset of VAP (VAP + 1) 619 ± 110, at 3 (VAP + 3)

    619 ± 111, and 5 (VAP + 5) 515 ± 116 day after onset compared with at 3 days before VAP (VAP - 3) 311 ±

    111 ( P < 0101) , but the decrease in CP IS was significant at 7 (VAP + 7) 217 ± 118 day after VAP onset

    ( P < 0101) 1 I n patientswith a CP IS > 6 at 5 days afterVAP onset, the mortalitywas higher than those with

    a CP IS < 6 ( P = 0100) 1The sensitivity and s pecificity of p redicted mortality was 9618 percent and 7412

    percent res pectively1 There was a significant correlati on bet ween CP IS score and length of mechanical

    ventilati on ( r = 01526, P = 0100) and length of res p irat ory intensive care unit stay ( r = 01449, P = 0100)

    and the length of hos p ital stay ( r = 01519, P = 0100) 1Patients receiving adequate therapy showed a slight

    fall in CP IS atVAP + 5,whereas those with inadequate therapy did not1 Conclusi on Serialmeasurement of

    CP IS is valuable in p redicting the severity of illness and evaluating the effect of therapy and p r ognosis1

    【Key words】 Pneumonia; Clinical pul monary infecti on score

    呼吸机相关肺炎 (VAP)是机械通气过程中最

    常见的并发症 ,它延长了患者呼吸重症监护室

    (R I CU)的停留时间 ,增加危重患者的死亡危险[ 1 ] ......