| 向绍山,蔡懿,罗世林,等.ICU呼吸机相关性肺炎病人短期死亡的危险因素研究[J].安徽医药,2026,30(6):1139-1144. |
| ICU呼吸机相关性肺炎病人短期死亡的危险因素研究 |
| Risk factors for short-term mortality in patients with ventilator-associated pneumonia in the ICU |
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| DOI：10.3969/j.issn.1009-6469.2026.06.016 |
| 中文关键词: 肺炎，呼吸机相关性 重症监护室 短期死亡 中性粒细胞与淋巴细胞比值 降钙素原 C反应蛋白 |
| 英文关键词: Pneumonia, ventilator-associated Intensive care unit Short-term death Neutrophil to lymphocyte ratio Procalcito. nin C-reactive protein |
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| 中文摘要: |
| 目的研究重症监护室( ICU)呼吸机相关性肺炎( VAP)病人短期死亡的危险因素。方法回顾性分析 2021年 12月至 2023年 12月于巴中市中心医院呼吸 ICU收治的 115例 VAP病人的临床资料，依据病人住院治疗 28 d内生存情况分为生存组(n=85)和死亡组( n=30)。统计两组基础资料信息及血清中性粒细胞与淋巴细胞比值( NLR)、血小板与淋巴细胞比值( PLR)、单核细胞与淋巴细胞比值( MLR)、 C反应蛋白( CRP)、降钙素原( PCT)、白细胞计数水平，以多因素 logistic回归分析探索 ICU VAP病人短期死亡的独立危险因素，受试者操作特征曲线( ROC曲线)分析血清指标预测 ICU VAP病人短期死亡的价值。结与生存组相比，死亡组年龄 ≥60岁病人占比更高［ 60.00%(18/30)比 35.29%(30/85)］且机械通气时间［( 10.42±1.37)d比(6果.24±1.04)d］、急性生理学和慢性健康状况评价 Ⅱ(APACHEⅡ)评分［( 20.48±2.11)分8.45±1.52)分］血清 PLR(183.38± 比(1，14.65比 171.04±14.12)NLR(10.03±2.52比7.31±1.34)MLR(0.51±0.12比 0.39±0.11)PCT［(1.74±0.25)μg/L比.08±0.17)μg/L］、 (1，CRP［(0.93±0.13)mg/L比(、0.53±0.08)mg/L］、白细胞计数、［( 15.32±2.03)×109/L比( 10.58、±1.59)×109/L］水平均更高( P<0.05)。多因素回归分析发现，年龄 ≥60岁， APACHEⅡ高评分，较长机械通气时间，血清 PLR、NLR、MLR水平较高， PCT、CRP、白细胞计数水平升高均是病人短期死亡的危险因素(均 P<0.05)。 ROC曲线分析证实，血清 NLR、PLR、MLR、PCT、CRP、白细胞计数水平均可用于 ICU VAP病人短期死亡风险的评估，曲线下面积分别为 0.83、0.75、0.76、0.94、0.92、0.86(均 P<0.05)。结论年龄 ≥60岁，机械通气时间较长， APACHEⅡ高评分，血清 NLR、PLR、MLR水平较高， PCT、CRP、白细胞计数水平升高均是 ICU VAP病人短期死亡的危险因素，临床上应给予足够重视。 |
| 英文摘要: |
| Objective To investigate the short-term risk factors for death in patients with ventilator-associated pneumonia (VAP) in the intensive care unit (ICU).Methods A retrospective analysis was conducted on the clinical data of 115 patients with VAP who wereadmitted to the Respiratory Intensive Care Unit of Bazhong Central Hospital from December 2021 to December 2023.The patients weredivided into the survival group (n=85) and the death group (n=30) based on their survival status within 28 days of hospitalization. The basic data and and serum levels of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and monocyte-to-lympho. cyte ratio (MLR), C-reactive protein (CRP), procalcitonin (PCT), white blood cell count in the two groups were analyzed. Multivariate lo.gistic regression analysis was performed to explore the independent risk factors for short-term mortality in ICU patients with VAP, andreceiver operating characteristic curves (ROC curves) were drawn to analyze the value of serum markers in predicting short-term death in these patients.Results Compared with the survival group, the proportion of patients aged ≥60 years in the death group was higher [60.00% (18/30) vs. 35.29% (30/85)], and the mechanical ventilation time [(10.42±1.37) d vs. (6.24±1.04) d], the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score [(20.48±2.11) points vs. (18.45±1.52) points], serum PLR (183.38±14.65 vs. 171.04± 14.12), NLR (10.03±2.52 vs. 7.31±1.34), MLR (0.51±0.12 vs. 0.39±0.11), PCT [(1.74±0.25) μg/L vs. (1.08±0.17) μg/L], CRP [(0.93± 0.13) μg/L vs. (0.53±0.08) μg/L], and white blood cell count [(15.32±2.03) ×109/L vs. (10.58±1.59) ×109/L] were all higher (P<0.05).Multivariate regression analysis revealed that age ≥60 years, a high APACHE Ⅱ score, a longer mechanical ventilation time, higher se.rum PLR, NLR, and MLR levels, and elevated serum PCT, CRP, and white blood cell count were all risk factors for short-term mortality in these patients (P<0.05). ROC curve analysis confirmed that serum NLR, PLR, MLR, PCT, CRP, and white blood cell count levelscould all be used to assess the short-term mortality risk of ICU patients with VAP. The areas under the curve (AUCs) were 0.83, 0.75, 0.76, 0.94, 0.92, and 0.86, respectively (all P<0.05). Conclusions Age ≥60 years, prolonged mechanical ventilation time, a highAPACHE Ⅱ score, and high serum levels of NLR, PLR, MLR, PCT, CRP, and white blood cell count are all risk factors for short-term mortality in ICU patients with VAP. Clinicians should pay sufficient attention to these factors. |
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