首次血清降钙素原水平在评价呼吸机相关性肺炎感染程度和预后的意义  

The Clinical Value of the First Serum Procalcitonin Level in Judgment of Severity of Infection and Prognosis Prediction of Patients with Ventilator-associated Pneumia

作　　者：张铂[1] 秦英智[2] 

机构地区：[1]天津市环湖医院三衰科,300070 [2]天津市第三中心医院ICU

出　　处：《天津医药》2009年第5期365-367,共3页Tianjin Medical Journal

摘　　要：目的:探讨首次血清降钙素原(PCT)水平对评价感染程度、呼吸机相关性肺炎(VAP)发生率和患者预后的临床意义。方法:用半定量固相免疫测定法测定血清PCT水平且机械通气时间>48h患者176例,按PCT水平分为<0.5μg/L,0.6～2.0μg/L,2.1～10.0μg/L和≥10.0μg/L4组,分析各组的VAP发生率、预后和细菌感染情况。结果:随着PCT水平升高,VAP发生率依次为8.24%、51.85%、69.05%和100%(P<0.01),多脏器功能衰竭(MODS)发生率依次为2.35%、14.81%、47.62%和95.45%(P<0.01),脱机成功率依次为91.76%、70.37%、47.62%和18.18%(P<0.01),病死率依次为8.24%、29.63%、52.38%和81.82%(P<0.01),G-杆菌感染率依次为40.00%、48.00%、53.33%和61.11%(P<0.01),真菌感染率依次为0、8.00%、15.56%和22.22%(P<0.01),机械通气时间和住ICU时间并无延长(P>0.05)。以PCT≥0.5μg/L为阈值,细菌感染阳性率为87.91%,阴性率为94.12%。结论:检测首次血清PCT水平对评价入院时感染严重度,预测VAP发生率及评价患者预后有指导意义。Objective： To explore the clinical values of the first serum proealcitonin （PCT）level in judgment of severity of infection, prediction of morbidity and prognosis of ventilator-associated pneumonia（VAP） of patients. Methods： One hundred and seventy-six patients ventilated more than 48 hours were detected the serum PCT level in the first day of ICU from Jan to Dec 2006. The patients were divided into 4 groups depending on the 4 different levels of serum PCT. The PCT levels were determined with the method of semi-solid phase immunoassay and graded into four levels, 〈0.5 μg/L, 0.6-2.0 μg/L, 2.1 ～10.0 μg/L and ≥ 10.0 μg/L. The serum PCT level, severity of infection, morbidity and prognosis of VAP patients were analyzed. Results：With increasing in the levels of serum PCT, the morbidity of VAP were 8.24%, 51.85%, 69.05% and 100% （P 〈 0.01）; the morbidity of multiple organ dysfunction syndrome（MODS） were 2.35%, 14.81%, 47.62% and 95.45% （P 〈 0.01）; the rates of successful weaning from mechanical ventilation were 91.76%, 70.37%, 47.62% and 18.18% （P 〈 0.01）; the case-fatality rates （CFR） were 8.24%,29.63%,52.38%,81.82%（P 〈 0.01 ）; the percentages of Gram-negative bacilli were 40.00%, 48.00%, 53.33% and 61.1 l%（P 〈 0.01 ）; the percentages of fungi were 0.00%, 8.00%, 15.56% and 22.22%（P 〈 0.01 ）; the duration of ventilation and the length of ICU stay were no prolongation, ff serum PCT≥0.50μg/L was regarded as the cutoff value,the PCT positive prediction rate was 87.91%, the PCT negative prediction rate was 94.12%. Conclusion： The first serum PCT level has clinical values in judgment of infection severity, prediction of morbidity and prognosis in VAP patients

关 键 词：降钙素 肺炎 预后 细菌感染 通气机 机械 

分 类 号：R563.1[医药卫生—呼吸系统] R51[医药卫生—内科学]