PSI 和CURB-65 評分在評估醫療護理相關性肺炎病情嚴重程度中的應用_《中國呼吸與危重監護雜志》

作者：

劉學東 ¹ , 韓秀迪 ¹ , 欒念旭 ¹ , 魏東 ¹ , 劉彧展 ¹ , 施毅 ²

1 青島市市立醫院呼吸科( 山東青島266011);;
2 南京軍區南京總醫院呼吸科( 江蘇南京210002)通信作者: 劉學東, E-mail: xuedongliu@ 263. net;

關鍵詞：

醫療護理相關性肺炎 CURB-65 評分肺炎嚴重度指數降鈣素原 C 反應蛋白

DOI：

DOI: 10 . 7507 /1671 -6205 . 20130110

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目的探討肺炎嚴重度指數( PSI) 和CURB-65 評分及降鈣素原( PCT) 、C 反應蛋白( CRP) 在醫療護理相關性肺炎( HCAP) 病情評估中的應用價值, 以指導臨床治療。
方法按照我國肺炎分類標準及PSI 和CURB-65 評分系統將92 例HCAP患者分為高危組、中危組及低危組, 分別比較PCT、CRP、白細胞( WBC) 和中性粒細胞百分比( Neu) 在3 組間的差異性和相關性; 構建ROC 曲線分析PSI、CURB-65 評分及血清PCT、CRP對住院HCAP 患者死亡的預測價值。
結果重癥組HCAP患者PSI 和CURB-65 評分以及PCT、CRP、WBC 和Neu 水平顯著高于非重癥組HCAP 患者( P lt;0. 05) ; 按PSI 和CURB-65 評分高危組HCAP患者血清PCT、CRP、WBC 和Neu 水平顯著高于低危組( P lt;0. 05) , 其中WBC 和Neu% 水平顯著高于中危組。PSI 和CURB-65 評分與血清PCT及CRP水平呈正相關。入院時PSI 評分 gt; 120 分或CURB-65 評分 gt; 2 分為死亡的預測因素。
結論 PSI 和CURB-65 評分與HCAP的病情嚴重程度具有一定的相關性, 聯合并監測血清PCT及CRP 水平可以提高HCAP患者嚴重程度的預測準確性。

引用本文： 劉學東,韓秀迪,欒念旭,魏東,劉彧展,施毅. PSI 和CURB-65 評分在評估醫療護理相關性肺炎病情嚴重程度中的應用. 中國呼吸與危重監護雜志, 2013, 12(5): 457-460. doi: DOI: 10 . 7507 /1671 -6205 . 20130110 復制

1.	參考文獻.
2.	American Thoracic Society; Infectious Diseases Society of America.Guidelines for the management of adults with hospital-acquired,ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171: 388-416 .
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5.	Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax, 2003;58:377-382.
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7.	CarratalàJ, Mykietiuk A, Fernández-SabéN, et al. Health careassociated pneumonia requiring hospital admission: epidemiology,antibiotic therapy, and clinical outcomes. Arch Intern Med, 2007 ,.
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12.	Krüger S, Ewig S, Marre R, Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J, 2008 , 31: 349 -355.
13.	: 1393-1399.

1. 參考文獻.
2. American Thoracic Society; Infectious Diseases Society of America.Guidelines for the management of adults with hospital-acquired,ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171: 388-416 .
3. 中華醫學會呼吸病學分會. 社區獲得性肺炎診斷和治療指南.中華結核和呼吸雜志, 2006, 29 : 651-655 .
4. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med, 1997, 336: 243-250.
5. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax, 2003;58:377-382.
6. Kollef MH, Shorr A, Tabak YP, et al. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest, 2005, 128 : 3854 -3862.
7. CarratalàJ, Mykietiuk A, Fernández-SabéN, et al. Health careassociated pneumonia requiring hospital admission: epidemiology,antibiotic therapy, and clinical outcomes. Arch Intern Med, 2007 ,.
8. Shindo Y, Sato S, Maruyama E, et al. Health-care-associated pneumonia among hospitalized patients in a Japanese community hospital. Chest, 2009 , 135: 633-640 .
9. Micek ST, Kollef KE, Reichley RM, et al. Health care-associatedpneumonia and community-acquired pneumonia: a single-center experience. Antimicrob Agents Chemother, 2007, 51 : 3568 -3573 .
10. Fang WF, Yang KY, Wu CL, et al. Application and comparison of scoring indices to predict outcomes in patients with healthcareassociated pneumonia. Crit Care, 2011 , 15: R32.
11. Hirakata Y, Yanagihara K, Kurihara S, et al. Comparison of usefulness of plasma procalcitonin and C-reactive protein measurements for estimation of severity in adults with community-acquired pneumonia.Diagn Microbiol Infect Dis, 2008,61:170-174.
12. Krüger S, Ewig S, Marre R, Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J, 2008 , 31: 349 -355.
13. : 1393-1399.

《中國呼吸與危重監護雜志》

PSI 和CURB-65 評分在評估醫療護理相關性肺炎病情嚴重程度中的應用

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《中國呼吸與危重監護雜志》

PSI 和CURB-65 評分在評估醫療護理相關性肺炎病情嚴重程度中的應用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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