血清降钙素原测定对机械通气患者发生呼吸机相关性肺炎的诊断价值

目的：评价血清降钙素原（PCT）测定对机械通气患者发生呼吸机相关性肺炎（VAP）的诊断价值。方法：将2011年6月1日-2012年6月1日连续收住我科机械通气（MV）超过48h的患者作为观察对象，排除存在既往感染或肺外器官感染的患者。当临床怀疑VAP时，患者入选，当日测定血清PCT和C反应蛋白（CRP）水平，记录人选24h内最高体温和白细胞计数、中性粒细胞绝对值，以及患者预后。结果：50例入选患者中，依据病原学标本，确诊VAP23例，未确诊27例。确诊VAP组患者血清PCT1．87（o．91，13．82）ng／ml]、CRP（16．54±6．86）mg／L]水平及最高体温（39．O±1．1）℃]明显高于未确诊VAP组O．25（O．10，0．49）ng／ml，（12．87土4．40）mg／L，（37．9士1．4）℃]。所有炎症指标中，PCT的敏感性（〉90％）、特异性（〉70％）和诊断正确率（〉80％）最高。结论：与传统炎症指标相比，PCT测定更有助于呼吸机相关性肺炎的诊断。

Diagnostic Value of Serum Procalcitonin for Mechanically Ventilated Patients with Ventilator-associated Pneumonia

Objective; To evaluate the diagnostic value of serum procalcitonin for mechanically ventilated （MV） pa- tients with ventilator-associated pneumonia. Methods.-Patients who required more than 48 hours of mechanical ventila- tion from June 1st 2011 to June 1st 2012 at the ICU in the First people＇s hospital of Lianyungang were enrolled, exclu- ding previous or extra-pulmonary organ infection. Patients suspected of VAP were included, then we measured the ser- um procalcitonin and C-reactive protein levels on the day of admission and recorded maximal body temperature, white blood cell count, absolute neutrophil count and prognosis. Results：Among the enrolled patients 23 cases were microbio- logically confirmed, relatively 27 cases were refuted. Serum procalcitonin 1. 87 （0. 91, 13. 82）ng/ml] and C-reactive protein levels （ 16.54 ＋ 6. 86） mg/L], and maximal body temperature（39. 0 ＋ 1.1 ~C ） with VAP were significantly higher than those without VAP-0. 25（0. 10,0. 49）ng/ml, （12. 87-4-4. 40）rag/L, （37. 9＋1.4）C]. The sensitivity（~〉90）, specificity（〉70） and diagnosis rate（〉80%）of serum PCT determination for the diagnosis of VAP were supreme. Conclusion： In comparison with the conventional inflammatory makers, serum PCT is more reliable indicator in early di- agnosis of VAP.