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目的探究降钙素原(PCT)在呼吸机相关性肺炎(VAP)早期诊断中的临床作用及意义。方法应用前瞻性临床研究方法,选择2013年1月至2013年6月收住重症监护室(ICU)连续接受呼吸机辅助通气达48 h或以上的患者82例作为研究对象,按照机械通气7 d内是否引起VAP分为VAP组46例和非VAP组36例。监测两组患者通气前和通气7 d后(非VAP组)或确诊VAP时(VAP组)的血清PCT水平,并对结果进行分析。结果 VAP组确诊时和非VAP组机械通气后血清PCT水平分别为(2.86±1.78)ng/ml和(0.36±0.17)ng/ml,前者明显高于后者,差异有统计学意义(P<0.01)。两组机械通气后不同血清PCT水平分布情况比较,也显示VAP组PCT水平升高者比率显著高于非VAP组。血清PCT诊断VAP的灵敏度和特异度(截断值:PCT=0.5 ng/ml)分别为87.0%和75.0%,比数积为20,约登指数为0.62。结论 PCT在VAP的诊断中灵敏度较高,通过监测PCT能够在早期更迅速地对VAP进行诊断。
Objective To investigate the clinical significance and significance of procalcitonin (PCT) in the early diagnosis of ventilator-associated pneumonia (VAP). Methods A prospective clinical study was conducted to select 82 patients admitted to intensive care unit (ICU) receiving continuous ventilatory ventilation for 48 hours or more between January 2013 and June 2013 as study subjects. The patients undergoing mechanical ventilation for 7 days VAP group was divided into 46 cases of VAP group and 36 cases of non-VAP group. Serum PCT levels were monitored before ventilation and 7 days after ventilation (non-VAP group) or VAP group (VAP group), and the results were analyzed. Results The serum PCT levels in the VAP group after mechanical ventilation were (2.86 ± 1.78) ng / ml and (0.36 ± 0.17) ng / ml respectively, which were significantly higher than those in the VAP group (P < 0.01). Comparing the distribution of PCT in different serum after mechanical ventilation, the ratio of PCT level in VAP group was significantly higher than that in non-VAP group. The sensitivity and specificity of serum PCT in diagnosing VAP (cut-off value: PCT = 0.5 ng / ml) were 87.0% and 75.0%, respectively. The log product was 20 and the Youden index was 0.62. Conclusions PCT is more sensitive in the diagnosis of VAP, and VPC can be more rapidly diagnosed early by monitoring PCT.