[1]孙宝玲,郭梅凤,王乃玲,等.降钙素原在重症颅脑疾病呼吸机相关性肺炎早期诊断中的作用[J].临床神经外科杂志,2018,15(01):50-54.[doi:10.3969/j.issn.1672-7770.2018.01.012]
 SUN Bao-ling,GUO Mei-feng,WANG Nai-ling,et al.Role of serum procalcitonin in early diagnosis of ventilator-associated pneumonia for patients with severe craniocerebral diseases[J].Journal of Clinical Neurosurgery,2018,15(01):50-54.[doi:10.3969/j.issn.1672-7770.2018.01.012]
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降钙素原在重症颅脑疾病呼吸机相关性肺炎早期诊断中的作用()
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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
15
期数:
2018年01期
页码:
50-54
栏目:
论著
出版日期:
2018-02-15

文章信息/Info

Title:
Role of serum procalcitonin in early diagnosis of ventilator-associated pneumonia for patients with severe craniocerebral diseases
作者:
孙宝玲郭梅凤王乃玲杨中良钱忠心赵明珠刘卫东张正银
200125上海市浦南医院NICU(孙宝玲,郭梅凤),心内科(王乃玲),神经内科(杨中良),神经外科(钱忠心,赵明珠,刘卫东 ),检验科(张正银)
Author(s):
SUN Bao-lingGUO Mei-fengWANG Nai-linget al.
NICU,Punan Hospital,Shanghai 200125,China
关键词:
降钙素原重症颅脑疾病呼吸机相关性肺炎临床肺部感染评分
Keywords:
procalcitoninventilator-associated pneumoniasevere craniocerebral diseasesclinical pulmonary infection score
分类号:
R563.1
DOI:
10.3969/j.issn.1672-7770.2018.01.012
文献标志码:
A
摘要:
目的 探讨血清降钙素原(PCT)水平与重症颅脑疾病所患呼吸机相关性肺炎(VAP)的关系,以及PCT对VAP早期诊断的意义;评价血清PCT及PCT结合临床肺部感染评分(CPIS)早期诊断VAP的特异性、敏感性。方法 2014年8月1日~2016年12月31日NICU收治的60例需有创机械通气的重型颅脑疾病患者;根据病情分为VAP组(40例)和肺部正常组(20例)。动态监测两组患者的血清PCT水平及体温、呼吸道分泌物和CPIS评分,检测血白细胞数和C反应蛋白(CRP)。比较两组患者的血清PCT水平;并将VAP组患者按预后分为好转组和进展组,分析比较其PCT及CPIS分值。结果 VAP组第1~7 d血清PCT水平均明显高于正常组,差异有统计学意义(均P<0.05);VAP组的血清PCT水平峰值于第6 d出现。治疗7 d后,VAP组患者中病情好转24例,进展16例。VAP进展组患者第1~6 d血清PCT水平高于好转组,但差异无统计学意义;第7 d差异有统计学意义(P<0.05)。VAP进展组与好转组患者第1 d、第3 d CPIS评分比较,差异无统计学意义(均P>0.05),第5 d、第7 d进展组高于好转组,差异有统计学意义(均P<0.001)。PCT用于诊断重症颅脑疾病VAP的敏感性为92.5%,特异性为85.0%;PCT联合CPIS评分诊断重症颅脑疾病VAP的敏感性为95.0%,特异性为90.0%。结论 PCT检测可提高重症颅脑疾病VAP早期诊断的准确率,其敏感性和特异性较好。动态监测PCT,并结合CPIS评分对重症颅脑疾病患者的VAP诊断及预后具有重要的临床指导意义。
Abstract:
Objective To analyse the relationship between serum procalcitonin(PCT) and ventilator-associated pneumonia(VAP),explore the early diagnostic value of serum PCT in VAP and evaluate the specificity and sensitivity of serum PCT and PCT associated with clinical pulmonary infection score(CPIS)for the early diagnostic value of VAP.At the same time,the early sensitivity and specificity for diagnosis of VAP between single PCT and PCT combining CPIS were observed.Methods 60 patients with severe craniocerebral diseases who used invasive mechanical ventilation in our hospital's NICU from August 1st to December 31st,2014 were selected.According to patients'condition,they were divied into VAP group(n=40) and non VAP group(n=20).Body temperature ,respiratory secretions,and CPIS were monitored dynamicly,and the level of white blood cell ,PCT and C reactive protein(CRP) were also tested.Differences of serum PCT between two groups were compared.VAP group was divied into improvement group and worsen group according to the prognosis.Differences of serum PCT and CPIS between two groups were compared.Results The level of PCT in VAP group was obviously higher than that in normal group(all P<0.05) from the 1st day to the 7th day,and the peak value of PCT in VAP group appear on the 6th day.After treatment for seven days,24 patients'condition improved,but 16 patients' condition got worse in VAP group.We observed the dynamic changes of PCT between the two groups:the level of PCT in worsen group was higher than that in improvement group from 1st day to 6th day ,but there was no statisical difference,but the level of PCT between two groups has statisical difference on 7th day(P<0.05).There was no statisical difference for CPIS on 1st day and 3rd day between the two groups(all P>0.05),but CPIS of worse group was higher than that of improvement group(all P<0.001) on 5th day and 7th day.The sensitivity of single PCT in the diagnosis of VAP for the patients with severe craniocerebral diseases was 92.5%,and the specificity was 85.0%.The sensitivity of PCT combining CPIS in the diagnosis of VAP for the patients with severe craniocerebral diseases was 95.0%,and the specificity was 90.0%.Conclusions Monitoring of PCT can improve the accuracy of early diagnosis of VAP for the patients with severe craniocerebral diseases,and have good sensitivity and specificity.Dynamic monitoring of PCT and PCT combining CPIS has important clinical value for the diagnosis and prognosis of VAP for the patients with severe craniocerebral diseases.

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更新日期/Last Update: 1900-01-01