气管镜下SEH评分对重症患者机械通气相关性肺炎的评估价值  

The value of SEH scores during bronchoscopy in evaluating of ventilator-associated pneumonia in critical patients

作　　者：杨义益[1] 杨兰[1] 梁国鹏[1] 张艳[2] 周永方[1] 代海霞 刘一琳 王波[2] 康焰[2,3] YANG Yiyi;YANG Lan;LIANG Guopeng;ZHANG Yan;ZHOU Yongfang;DAI Haixia;LIU Yilin;WANG Bo;KANG Yan(Department of Respiratory Care,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Critical Care Medicine,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Critical Care Medicine,West China Tianfu Hospital of Sichuan University,Chengdu,Sichuan,P.R.China)

机构地区：[1]四川大学华西医院呼吸治疗科,四川成都610041 [2]四川大学华西医院重症医学科,四川成都610041 [3]四川大学华西天府医院重症医学科,四川成都610213

出　　处：《中国呼吸与危重监护杂志》2025年第2期107-114,共8页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家重点研发计划(2022YFC2504500);四川大学华西医院学科卓越发展1·3·5工程(ZYGD23012)。

摘　　要：目的观察重症患者机械通气相关性肺炎(Ventilator-associated pneumonia,VAP)与支气管镜下黏膜及痰液改变情况的关系,制定了针对气道痰液(Sputum)、黏膜水肿(Edema)、黏膜充血(Hyperemia)异常程度的SEH评分预测模型并对纳入患者进行SEH评分,分析支气管镜下SEH评分对VAP的诊断价值。方法纳入观察2024年3月1日—2024年7月1日收治入四川大学华西医院重症医学科接受支气管镜检查的机械通气的365例患者一般资料和首次接受支气管镜检查时镜下黏膜与痰液情况,根据VAP诊断标准,以首次气管镜检查后72 h内是否诊断VAP将患者分为感染组(n=138)与非感染组(n=227),使用t检验对比两组患者的基线资料、方差分析检验两组患者气道黏膜及痰液病变的差异性。基于二分类Logistic回归构建SEH评分感染预测风险列线图。采用受试者操作特征曲线(Receiver operating characteristic curve,ROC),计算ROC曲线下面积评价预测模型准确性。结果共365名患者纳入分析,138(37.8%)名患者被诊断存在VAP,SEH评分对VAP诊断预测回归分析ROC曲线下面积(Area Under Curve,AUC)为0.81[95%置信区间(confidential interval,CI)0.76-0.85],SEH评分最佳截断值为6.5,对VAP诊断敏感性为79.7%(95%CI:72.2%-85.6%),特异性为73.1%(95%CI:67.0%-78.5%),SEH评分>6.5分的患者具有更高的VAP感染率(64.3%vs.14.4%,P<0.0001),同时具有更高的白细胞计数(White blood cell,WBC)水平(13.3±7.5 vs.11.8±6.2,P=0.04)及更高的住院死亡率(39.8%vs.24.2%,P=0.002)。结论SEH评分对机械通气患者VAP的诊断具有一定效能,相对于传统VAP诊断标准能更容易在临床获取,具有一定临床应用价值。Objective To observe the relationship between ventilator-associated pneumonia(VAP)and changes in bronchial mucosa and sputum in critically ill patients.A prediction model for SEH score was developed according to the abnormal degrees of airway sputum,mucosal edema and mucosal hyperemia,as well as to analyze the diagnostic value of the SEH scores for VAP during bronchoscopy.Methods A collection of general data and initial bronchoscopy results was conducted for patients admitted to the department of intensive care unit at West China Hospital from March 1,2024,to July 1,2024.Patients were divided into infection group(n=138)and non-infection group(n=227)according to diagnostic criteria for VAP based on the date of their first bronchoscopy.T-tests were used to compare baseline data between groups,while analysis of variance was employed to assess differences in airway mucosal and sputum lesions.A binary logistic regression model was constructed using the SEH scores for predicting VAP risk,with receiver operating characteristic curve area under the curve(AUC)utilized to evaluate model accuracy.Results A total of 365 patients were included in this study,among which 138 cases(37.8%)were diagnosed with VAP.The AUC for using SEH scores in diagnosing VAP was found to be 0.81[95%confidence interval(CI)0.76-0.85],with an optimal cutoff value set at 6.5.The sensitivity and specificity of SEH scores for diagnosing VAP were determined as 79.7%(95%CI:72.2%-85.6%)and 73.1%(95%CI:67.0%-78.5%).Patients with SEH scores over 6.5 exhibited a significantly higher rate of VAP infection(64.3%vs.14.4%,P<0.0001),elevated white blood cell count levels(WBC)[(13.3±7.5 vs.1.8±6.2),P=0.04],as well as increased hospital mortality rates(39.8%vs.24.2%,P=0.002).Conclusions The SEH scores has a certain efficacy in the diagnosis of VAP in patients with mechanical ventilation.Compared with the traditional VAP diagnostic criteria,SEH scores is easier to obtain in clinical practice,and has certain clinical application value.

关 键 词：机械通气相关性肺炎 支气管镜检查 肺部感染 机械通气 预测模型. 

分 类 号：R563.1[医药卫生—呼吸系统] R459.7[医药卫生—内科学]