| 戚莲萍,周兴梅,盛 怡,费凯红,庄燕萍.ICU呼吸机相关性肺炎患者病原菌分布及NLR、血清磷、PCT联合检测对死亡风险的预测价值探讨[J].,2023,(2):263-267 |
| ICU呼吸机相关性肺炎患者病原菌分布及NLR、血清磷、PCT联合检测对死亡风险的预测价值探讨 |
| Predictive Value Discussion of Combined Detection on Mortality Risk of Pathogenic Bacteria Distribution, Neutrophil to Lymphocyte Count Ratio, Serum Phosphorus and Procalcitonin in Patients with Ventilator Associated Pneumonia in ICU |
| 投稿时间：2022-06-10 修订日期：2022-07-06 |
| DOI：10.13241/j.cnki.pmb.2023.02.011 |
| 中文关键词: 呼吸机相关性肺炎 病原菌 中性粒细胞与淋巴细胞计数比值 血清磷 降钙素原 |
| 英文关键词: Ventilator-associated pneumonia Pathogenic bacteria Neutrophil to lymphocyte count ratio Serum phosphorus Procalcitonin |
| 基金项目:上海市卫生计生系统重要薄弱学科建设计划项目（2018ZB0405）；上海市松江区科学技术攻关项目（2019SJKJ6602） |
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| 中文摘要: |
| 摘要 目的：研究重症监护室（ICU）呼吸机相关性肺炎（VAP）患者病原菌分布及中性粒细胞与淋巴细胞计数比值（NLR）、血清磷、降钙素原（PCT）联合检测对死亡风险的预测价值。方法：选取上海市第一人民医院于2020年1月～2022年1月收治的60例VAP患者。采集所有患者呼吸道分泌物并进行细菌培养。此外，将其按照预后的不同分为死亡组21例以及存活组39例，比较两组NLR、血清磷及PCT水平。以单因素及多因素Logistic分析VAP患者死亡的危险因素，并通过受试者工作特征（ROC）曲线分析NLR、血清磷及PCT预测死亡的效能。结果：60例VAP患者呼吸道分泌物检出病原菌共82株，以革兰阴性菌占比最高，共检出革兰阴性菌75.61%、革兰阳性菌21.95%、真菌2.44%。按照占比从高到低的顺序分别为鲍氏不动杆菌20.73%，铜绿假单胞菌18.29%，肺炎克雷伯菌17.07%，金黄色葡萄球菌13.41%，大肠埃希菌12.20%，其他革兰阴性菌7.32%，表皮葡萄球菌4.88%，肠球菌属3.66%，真菌2.44%。死亡组NLR及PCT水平均高于存活组，而血清磷水平低于存活组（P＜0.05）。单因素分析结果显示：急性生理与慢性健康评分（APACHEⅡ）评分及有创机械通气时间均和VAP患者死亡有关（P＜0.05）。多因素Logistic回归分析显示：APACHEⅡ评分较高、有创机械通气时间较长与NLR、PCT水平较高均是VAP患者死亡危险因素，血清磷水平较高是VAP患者死亡的保护因素（P＜0.05）。ROC曲线分析显示：NLR、血清磷及PCT联合预测VAP患者死亡的效能优于上述三项指标单独预测。结论：VAP患者主要病原菌为革兰阴性菌，临床应合理选用抗菌药物治疗，NLR、血清磷及PCT均和患者死亡有关，联合检测对死亡风险的预测价值较高。 |
| 英文摘要: |
| ABSTRACT Objective: To study the pathogenic bacteria distribution and the predictive value of combined detection on mortality risk of neutrophil to lymphocyte count ratio (NLR), serum phosphorus and procalcitonin (PCT) in patients with ventilator associated pneumonia (VAP) in intensive care unit (ICU). Methods: 60 patients with VAP who were admitted to Shanghai First People's Hospital from January 2020 to January 2022 were selected. Respiratory secretions were collected from all patients and bacterial culture was performed. In addition, according to the different prognosis, they were divided into death group with 21 cases and survival group with 39 cases. The levels of NLR, serum phosphorus and PCT were compared between the two groups. Univariate and multivariate Logistic analysis were used to analyze the risk factors for death in patients with VAP. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of NLR, serum phosphorus and PCT in predicting death. Results: 82 strains of pathogenic bacteria were detected in respiratory secretions of 60 cases of patients with VAP, and Gram-negative bacteria accounted for the highest proportion, with 75.61% of Gram-negative bacteria, 21.95% of Gram-positive bacteria and 2.44% of fungi. According to the order of proportion from high to low, they were Acinetobacter baumannii 20.73%, Pseudomonas aeruginosa 18.29%, Klebsiella pneumoniae 17.07%, Staphylococcus aureus 13.41%, Escherichia coli 12.20%, other Gram-negative bacteria 7.32%, Staphylococcus epidermidis 4.88%, Enterococcus 3.66%, Fungi was 2.44%. The levels of NLR and PCT in the death group were higher than those in the survival group, while the level of serum phosphorus was lower than that in the survival group (P＜0.05). Univariate analysis showed that acute physiology and chronic health score (APACHE Ⅱ) and invasive mechanical ventilation time were associated with death in patients with VAP(P＜0.05). Multivariate Logistic regression analysis showed that higher APACHE Ⅱ score, longer duration of invasive mechanical ventilation, higher levels of NLR and PCT were risk factors for death in patients with VAP, and higher serum phosphorus level was a protective factor for death in patients with VAP(P＜0.05). ROC curve analysis showed that the combination of NLR, serum phosphorus and PCT in predicting the death of patients with VAP was better than the above three indicators alone. Conclusion: The main pathogenic bacteria in patients with VAP are Gram-negative bacteria, and antibiotics should be used reasonably in clinical treatment. NLR, serum phosphorus and PCT are all related to the death of patients, and the combined detection has a high predictive value for the mortality risk. |
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