炎症介质对脑损伤患者呼吸机相关性肺炎的早期诊断和预测  

Prognostic role of inflammatory media to identify early ventilator-associated pneumonia brain injury

作　　者：张建军[1] 柴成国 于玉兰[1] 李敬[1] 崔朝勃[1] 王维展[1] 

机构地区：[1]河北省衡水市哈励逊国际和平医院急诊科,河北衡水053000

出　　处：《中国现代医学杂志》2014年第24期65-68,共4页China Journal of Modern Medicine

摘　　要：目的对脑损伤呼吸机相关性肺炎患者进行早期预测及诊断。方法选择脑损伤并且施行有创机械通气的患者55例。所有患者在入ICU机械通气第1天(D1)时测定:CPIS、PCT、CRP、IL-6和进行气管抽吸物培养。入ICU机械通气第4天(D4)对上述指标进行重新测定,并对数据进行统计学分析。结果 PCT预测早期VAP的敏感性为83.3%,特异性为77.4%;IL-6预测早期VAP的敏感性为70.8%,特异性为64.5%;CRP预测早期VAP的敏感性为62.5%,特异性为61.3%。PCT与CPIS在诊断早期VAP时具有较强的相关性,其相关系数r=0.853(P<0.05)。结论血清PCT水平对预测脑损伤患者早期VAP的敏感性及特异性高于CRP及IL-6。联合监测CPIS可能有助于提高早期VAP的诊断。【Objective】To early anticipate and diagnose ventilator associated pneumonia in patients with cerebral injuries. 【Methods】55 cerebral injury patients on ventilator admitted were chosen as the study subjects. The following parameters were examined on the 1st day（D1） on ventilator： CPIS score, PCT, CRP, IL-6, and aspirate was collected from trachea for cultivation. All the above examinations were repeated on the 4th day on ventilator（D4）. All data were statistically analyzed. 【Results】The sensitivity of PCT for predicting early VAP was 83.3%, specificity77.4%; the sensitivity of IL-6 for predicting early VAP was 70.8%, specificity 64.5%; the sensitivity of CRP for predicting early VAP was 62.5%, specificity 61.3%. PCT and CPIS were strongly correlated with early VAP, with a correlation coefficient r =0.853（P〈 0.05）.【Conclusions】Serum PCT level has higher sensitivity and specificity to predict early VAP than CRP and IL-6. Monitoring serum PCT may be helpful for anticipating early VAP, and combination with monitoring CPIS may be helpful to improve diagnosis of early VAP.

关 键 词：炎症介质 脑损伤 呼吸机相关性肺炎 早期诊断和预测 

分 类 号：R473.5[医药卫生—护理学]