河北医科大学学报 ›› 2021, Vol. 42 ›› Issue (6): 698-703.doi: 10.3969/j.issn.1007-3205.2021.06.017

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肺部超声评分与简化临床肺部感染评分对VAP早期诊断与预后评估的价值

  

  1. 1.广东省珠海市人民医院超声影像科， 广东 珠海 519000;2.广东省珠海市人民医院急诊科，广东 珠海 519000
  • 出版日期:2021-06-25 发布日期:2021-07-05
  • 作者简介:赵苑竹（1990-），女，山西太原人，广东省珠海市人民医院医师，医学学士，从事超声影像诊断研究。
  • 基金资助:
    广东省科学技术厅科技计划项目（2018ZC019）

The value of lung ultrasound score and simplified clinical pulmonary infection score in early diagnosis and prognostic evaluation of VAP

  1. 1.Department of Ultrasound Imaging, People′s Hospital of Zhuhai City, Guangdong Province, Zhuhai 
    519000, China; 2.Department of Emergency, People′s Hospital of Zhuhai City, 
    Guangdong Province, Zhuhai 519000, China
  • Online:2021-06-25 Published:2021-07-05

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摘要： 目的  分析肺部超声评分与简化临床肺部感染评分对呼吸机相关性肺炎（ventilator-associated pneumonia,VAP）早期诊断与预后评估的价值。
方法  选取医院ICU收治的VAP患者100例，所有患者均行肺部超声评分以及简化临床肺部感染评分检查，观察肺部超声评分以及简化临床肺部感染评分在VAP中的诊断准确率。同时观察患者治疗不同时间肺部超声评分以及简化临床肺部感染评分与白细胞计数（white blood cell count,WBC）、降钙素原（procalcitonin,PCT）以及高敏C反应蛋白（high sensitive C-reaction protein,hs-CRP）的变化，并分析肺部超声评分以及简化临床肺部感染评分对VAP患者预后的预测价值。
结果  肺部超声评分、简化临床肺部感染评分、胸部CT诊断VAP均具有较高准确率，但是三者比较差异无统计学意义(P＞0.05)；患者治疗7 d时肺部超声评分以及简化临床肺部感染评分与WBC、PCT以及hs-CRP均明显低于治疗3 d时，且差异有统计学意义（P＜0.05）；诊断后28 d内死亡26例，存活74例。多因素Logistic回归分析显示，使用抗生素、肺部超声评分、简化临床肺部感染评分、呼吸衰竭、插入方式、WBC、PCT、hs-CRP均为VAP患者预后的相关影响因素（P＜0.05）；ROC曲线分析显示，肺部超声评分、简化临床肺部感染评分对VAP患者预后价值的AUC分别为0.912、0.824；肺部超声评分截值为2.50，简化肺部感染评分截值为3.50，两种评分预测敏感度、特异度分别为：肺部超声评分为95.9%、73.1%；简化临床肺部感染评分为86.5%、73.1%，肺部超声评分的准确率更高。
结论  肺部超声评分以及简化临床肺部感染评分在VAP早期诊断和预后评估中均有着较好的应用价值，且肺部超声评分在VAP患者预后评价中的应用价值更高，值得推广使用。


关键词: 肺炎, 呼吸机相关性, 肺部超声评分, 简化临床肺部感染评分

Abstract: Objective  To analyze the value of lung ultrasound score(LUS) and simplified clinical pulmonary infection score(sCPIS) in early diagnosis and prognosis evaluation of VAP. 
Methods  A total of 100 hospitalized patients in ICU with ventilator-associated pneumonia(VAP) were selected. All patients underwent evaluation by LUS and sCPIS to observe the diagnostic accuracy of LUS and sCPIS in VAP. The LUS and sCPIS at different time of treatment as well as the changes in WBC, PCT and hs-CRP were observed, and the predictive value of LUS and sCPIS in the prognosis of VAP patients was analyzed. 
Results  LUS, sCPIS, and chest CT were of high accuracy in the diagnosis of VAP, however, there was no significant difference among them(P＞0.05). LUS and sCPIS as well as WBC, PCT and hs-CRP at 7 d after treatment were significantly lower than those at 3 d after treatment and the difference was statistically significant(P＜0.05). Within 28 d of diagnosis, 26 of 100 patients died, and 74 cases survived. Multivariate Logistic regression analysis showed that the use of antibiotics, LUS, sCPIS, respiratory failure, insertion mode, WBC, PCT and hs-CRP were all related influencing factors for VAP in patients(P＜0.05). ROC curve analysis showed that the AUC of LUS and sCPIS for prognostic prediction of VAP was 0.912, and 0.824 respectively. The LUS was 95.9% and 73.1% respectively and the sCPIS was 86.5% and 73.1%, respectively. The accuracy of LUS was higher. 
Conclusion  LUS  and sCPIS have good application value in early diagnosis and prognosis evaluation of VAP, and the application value of LUS in prognosis evaluation of VAP patients is higher, which is worthy of promotion and popularization. 


Key words: pneumonia, ventilator-associated, lung ultrasound score, simplified clinical pulmonary infection score

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