简化临床肺部感染评分在成人心脏直视术后呼吸机相关肺炎中的应用  

Application of simplified clinical pulmonary infection score to ventilator-associated pneumonia in adult patients following cardiac surgery

作　　者：尤颢[1] 廖崇先[1] 

机构地区：[1]厦门大学附属中山医院心脏外科,福建361004

出　　处：《中国急救医学》2011年第1期15-17,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的 评价简化临床肺部感染评分（sCPIS）在成人心脏直视术后呼吸机相关肺炎（VAP）中的临床应用价值.方法 选择本院心脏外科重症监护病房（CSICU）2007-01～2009-12连续收治的成人心脏直视术后符合VAP临床诊断及病原学诊断的29例患者为VAP组,术后无VAP等肺部感染的34例患者为对照组,比较两组sCPIS分值,并计算sCPIS不同分值对VAP诊断的敏感度和特异度.根据VAP患者sCPIS分值的变化情况,再将VAP患者分为改善组和非改善组,比较发病后第3天及第5天两组呼吸机使用时间、CSICU入住时间和死亡率.结果 VAP组发病日sCPIS分值与对照组比较差异无统计学意义（P＞0.05）;sCPIS分值5、6、7分对心脏直视术后VAP诊断的敏感度分别为93.1%、58.6%、24.1%,特异度分别为14.7%、52.9%、24.1%.改善组发病后第3天CSICU入住时间短于非改善组（P＜0.05）,发病后第5天呼吸机使用时间、CSICU入住时间及死亡率低于非改善组（P＜0.01或P＜0.05）.结论 sCPIS对心脏直视术后VAP的诊断准确性差,但通过动态观察sCPIS的变化有助于VAP的病情判断和预后评估.Objective To analyze the clinical value of simplified clinical pulmonary infection score （ sCPIS ） in ventilator - associated pneumonia （ VAP ） of adult patients undergoing open heart surgery with cardiopulmonary bypass. Methods Between January 2007 and December 2009 in our Cardiac Surgical Intensive Care Unit （CSICU） , a total of 29 consecutive adult patients who met the VAP clinical diagnosis criteria and positive culture of pleural fluid were enrolled in this study. 34 cases without VAP were selected as the control group. The VAP patients were divided into improvement group and poor group according to the change of sCPIS. The ventilation time, ICU stay and mortality were compared between two groups at the 3 rd and 5th day after VAP onset. Results There was no difference in sCPIS between the VAP and control group（ P 〉 0.05 ）. The sCPIS of 5,6, 7 in diagnosis of VAP had sensitivity of 93. 1%, 58. 6%, 24. 1%, and specificity of 14.7%, 52.9%, 24. 1% respectively. Compared with poor group, the improvement group had shorter ICU stay at 3rd day after VAP onset （P 〈 0.05）. At 5th day after VAP onset, the improvement group had shorter ventilation time, ICU stay and lower mortality （ P 〈 0.01 or 0.05）. Conclusion The sCPIS is of limited utility value in the diagnosis of VAP in open heart surgery of adult patients, while serial observation of the sCPIS is valuable in predicting the severity of illness and evaluating the prognosis.

关 键 词：临床肺部感染评分 心脏直视手术 呼吸机相关肺炎 

分 类 号：R562[医药卫生—呼吸系统]