ICU并发呼吸机相关肺炎患者外周血VCS参数与预后的关系  

Relationship between peripheral blood VCS parameters and prognosis of ICU patients complicated with ventilator-associated pneumonia

作　　者：钟倩 储蕴 肖旭阳 张岚 张凤香 ZHONG Qian;CHU Yun;XIAO Xu-yang;ZHANG Lan;ZHANG Feng-xiang(The First Affiliated Hospital of Jinzhou Medical University,Jinzhou,Liaoning 121000,China)

机构地区：[1]锦州医科大学附属第一医院重症医学科,辽宁锦州121000 [2]锦州医科大学附属第一医院胸外科,辽宁锦州121000 [3]锦州医科大学附属第一医院护理部,辽宁锦州121000

出　　处：《中华医院感染学杂志》2022年第13期1955-1959,共5页Chinese Journal of Nosocomiology

基　　金：辽宁省教育厅科学技术研究基金资助项目(JYTJCZR201908)。

摘　　要：目的探究重症监护室(ICU)并发呼吸机相关肺炎(VAP)患者外周血白细胞体积/电导率/散射率(VCS)参数变化及其与预后的关系。方法选择2019年5月-2021年3月锦州医科大学附属第一医院ICU病房收治的104例重症患者为研究对象,依据患者是否并发VAP将分为VAP组43例与非VAP组61例,VAP组患者依据28 d生存情况分为存活组28例与死亡组15例。测定并比较患者外周血白细胞VCS参数变化,分析其与VAP发生之间关系;比较不同预后VAP患者外周血白细胞VCS参数变化,分析VAP患者预后影响因素。结果VAP组患者白细胞(WBC)、中性粒细胞绝对值(ANC)、中性粒细胞平均体积(NV)、中性粒细胞平均传导率(NC)、淋巴细胞平均激光散射率(LS)水平高于非VAP组(P<0.05);WBC、ANC、NV、NC、LS对于VAP诊断曲线下面积(AUC)分别为0.776、0.840、0.831、0.667、0.703;死亡组患者WBC、ANC、NV、NC、LS水平高于存活组(P<0.05);单因素与多元Logistic回归分析显示,预防性应用抗菌药物为VAP患者预后重要影响因素(P<0.05)。结论VCS参数指标可以反映ICU重症并发VAP患者白细胞形态学变化,可用于预测VAP发生,同时与患者预后关系密切。OBJECTIVE To explore the relationship between the changes of peripheral blood white blood cell(WBC)volume/conductivity/scattering power(VCS)parameters and the prognosis of intensive care unit(ICU)patients complicated with ventilator-associated pneumonia(VAP).METHODS A total of 104 critically ill patients who were treated in ICUs of The First Affiliated Hospital of Jinzhou Medical University from May 2019 to Mar 2021 were recruited as the study sujects and divided into the VAP group with 43 cases and the non-VAP group with 61 cases according to the status of VAP.The patients of the VAP group were divided into the survival group with 28 cases and the death group with 15 cases according to the status of 28-day survival.The peripheral blood VCS parameters were compared among the patients,the relationship with incidence of VAP was observed,the peripheral blood VCS parameters were compared among the VAP patients with different treatment outcomes,and the influencing factors for prognosis of the VAP patients were analyzed.RESULTS The WBC,absolute neutrophil count(ANC),mean neutrophil volume(NV),mean neutrophil conductivity(NC)and mean laser light scattering of lymphocyte(LS)were significantly higher in the VAP group than in the non-VAP group(P<0.05).The areas under curves(AUCs)of WBC,ANC,NV,NC and LS were respectively 0.776,0.840,0.831,0.667 and 0.703 in diagnosis of VAP.The levels of WBC,ANC,NV,NC and LS of the death group were significantly higher than those of the survival group(P<0.05).Univariate analysis and multivariate logistic regression analysis showed that prophylactic use of antibiotics was a significant influencing factor for prognosis of the VAP patients(P<0.05).CONCLUSION The VCS parameters can reflect the morphological changes of WBC of the ICU patients complicated with VAP and can be used for prediction of VAP,which are closely associated with the prognosis of the patients.

关 键 词：重症监护室 呼吸机相关肺炎 外周血白细胞体积/电导率/散射率 临床意义 

分 类 号：R563。1[医药卫生—呼吸系统]