血清PCT联合EVLWI预测SCAP致ARDS预后价值  

Analysis on the value of serum PCT combined with EVLWI in predicting prognosis of patients with ARDS caused by SCAP

作　　者：王利利[1] 张强[1] 王卫国[1] WANG Li-li;ZHANG Qiang;WANG Wei-guo(Tengzhou Central People's Hospital,Tengzhou,Shandong 277599,China)

机构地区：[1]滕州市中心人民医院呼吸内科,山东滕州277599

出　　处：《中华医院感染学杂志》2021年第16期2421-2425,共5页Chinese Journal of Nosocomiology

基　　金：济宁医学院博士基金资助项目(JY2015KJ043)。

摘　　要：目的分析血清降钙素原(PCT)联合血管外肺水指数(EVLWI)预测重症社区获得性肺炎(SCAP)致急性呼吸窘迫综合征(ARDS)患者预后的价值,为优化临床治疗和预后评价工作提供研究依据。方法选取2017年1月-2019年1月滕州市中心人民医院呼吸内科收治的71例SCAP致ARDS患者作为研究对象。根据患者预后将其分为死亡组(住院期间因治疗无效死亡)及存活组(住院治疗有效康复出院)。对两组患者的基线资料、入院时白细胞计数(WBC)、血乳酸(Lac)、血清肌酐(Scr)、C-反应蛋白(CRP)及血清PCT水平进行调查和对比。患者入院后均给予颈内中心静脉置管,采用脉搏指示持续心排血量(PiCCO)监测仪对EVLWI等血流动力学指标进行监测。结果在住院期间有31例患者因治疗无效死亡,占43.66%。死亡组患者入院时氧合指数(OI)水平低于存活组(P<0.05)。死亡组患者入院时血清PCT水平和EVLWI水平分别为(18.40±5.64)ng/ml和(10.70±2.61)ml/kg,均高于存活组(P<0.05)。受试者工作特征(ROC)曲线分析结果显示,入院时血清PCT及EVLWI预测SCAP致ARDS患者预后的ROC曲线下面积(AUCROC)分别为0.828和0.790(P<0.05),当将二者联合检测时,AUCROC提升至0.960(P<0.05),灵敏度和特异度分别为0.903和0.875。结论SCAP致ARDS患者入院时的血清PCT和EVLWI水平均与其预后有关,其水平的升高提示着患者死亡风险的升高,临床医生应重视疾病早期的感染标志物水平和PiCCO指标监测,及时采取相关救治措施,以达到改善患者预后的目的。OBJECTIVE To analyze the value of serum procalcitonin(PCT)combined with extravascular lung water index(EVLWI)in predicting prognosis of patients with acute respiratory distress syndrome(ARDS)caused by severe community acquired pneumonia(SCAP),so as to provide research basis for optimizing clinical treatment and prognosis evaluation.METHODS Total of 71 patients with ARDS caused by SCAP hospitalized in Department of Respiratory medicine of Tengzhou Central People’s Hospital from Jan 2017 to Jan 2019 were recruited as the research subjects.According to the prognosis of the patients,they were divided into the death group(death due to ineffective treatment during hospitalization)and the survival group(effective rehabilitation and discharge after hospitalization).The baseline data as well as the white blood cell(WBC),blood lactic acid(Lac),serum creatinine(Scr),C-reactive protein(CRP)and the serum PCT levels at admission between the patients of the two groups were investigated and compared.After admission,the patients were treated with internal jugular central venous catheterization,whose hemodynamic indicators such as EVLWI were monitored by pulse indicator continuous cardiac output(PiCCO)monitor.RESULTS During hospitalization,31 patients died due to ineffective treatment,accounting for 43.66%.The oxygenation index(OI)level of the patients in the death group was significantly lower than that in the survival group(P<0.05).The serum PCT level and EVLWI level in the patients of the death group were(18.40±5.64)ng/mL and(10.70±2.61)ml/kg respectively,which were significantly higher than those in the survival group(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the area under ROC curve(AUCROC)of serum PCT and EVLWI in predicting prognosis of patients with ARDS caused by SCAP were 0.828 and 0.790,respectively(P<0.05).When the two indicators were combined,AUCROC was increased to 0.960(P<0.05),and the sensitivity and specificity were 0.903 and 0.875,respectively.CONCLUSION The serum PCT and EVLWI

关 键 词：降钙素原 血管外肺水指数 重症社区获得性肺炎 急性呼吸窘迫综合征 预后 

分 类 号：R563.8[医药卫生—呼吸系统]