【摘要】 目的 探讨快速现场评价（ROSE）联合高通量测序（NGS）在重症肺炎（SP）病原学诊断及治疗中的应用效果。方法 选取2021年4月至2024年4月沧州市人民医院收治的106例SP患者，根据患者是否接受ROSE联合NGS检查分为观察组56例（常规病原学和ROSE联合NGS检测）、对照组50例（常规病原学检测），对照组根据常规病原学结果调整抗感染治疗，观察组根据常规病原学和ROSE联合NGS结果调整抗感染治疗。分析ROSE联合NGS及常规病原学结果、抗感染调整情况、初始及根据病原学调整治疗1周后急性生理学及慢性健康状况（APACHEⅡ）、序贯器官衰竭（SOFA）评分及出院和28 d结局。结果 观察组ROSE联合NGS检测病原学阳性率高于常规检测（P<0.05）。ROSE联合NGS从56例患者中共检出病原体90株，常规病原学检出49株，ROSE联合NGS对细菌、真菌、特殊病原体的检出率高于常规病原学，但比较差异无统计学意义（P>0.05）。ROSE联合NGS诊断混合感染率高于常规检测（P<0.05）。观察组病原学结果有效指导率高于对照组（P<0.05）。观察组调整治疗1周后的APACHEⅡ、SOFA评分低于对照组（P<0.05）。观察组出院时死亡率和出院28 d全因死亡率均低于对照组（P<0.05）。结论 ROSE联合NGS技术可提高SP患者病原学诊断率，对临床治疗有指导作用，可改善患者短期预后。更多还原

【Abstract】 Objective To discuss the application effect of rapid on-site evaluation(ROSE) combined with high-throughput sequencing(NGS) in etiological diagnosis and treatment decision of severe pneumonia(SP). Methods 106 patients with SP who were admitted to Cangzhou People’s Hospital from April 2021to April 2024 were selected for this study. The patients were divided into two groups: an observation group(56cases receiving both conventional pathogen detection and combined detection of ROSE and NGS) and a control group(50 cases receiving only conventional pathogen detection). The control group received anti-infection treatment based on conventional pathogen detection results, while the observation group received treatment based on conventional pathogen detection and combined ROSE and NGS results. The study analyzed the results of ROSE combined with NGS, conventional pathogen detection, adjustments to anti-infection treatment, Acute Physiology and Chronic Health EvaluationⅡ （APACHEⅡ） scores and Sequential Organ Failure Assessment(SOFA) scores after 1 week of initial treatment, treatment adjustments based on pathogen detection results, discharge outcomes, and 28-day outcomes. Results The pathogen positivity rate detected by ROSE combined with NGS was higher than that detected by conventional methods(P<0.05). ROSE combined with NGS identified 90pathogen strains in 56 patients, whereas conventional pathogen detection only found 49 pathogen strains. The detection rates of bacteria, fungi and special pathogens by ROSE combined with NGS were higher than those of the conventional method, although the differences were not statistically significant(P>0.05). The rate of mixed infections diagnosed by ROSE combined with NGS was higher than that of conventional detection(P<0.05).The effective guidance rate of pathogenic results in the observation group was higher than that in the control group(P<0.05). APACHEⅡand SOFA scores of the observation group were lower than those of the control group after 1 week of adjusted treatment( P<0.05). The mortality at discharge and the 28-day all-cause mortality post-discharge were lower in the observation group than in the control group(P<0.05). Conclusion ROSE combined with NGS can enhance the etiological diagnosis rate of SP and offer guidance for clinical treatment, ultimately improving the short-term prognosis.更多还原