颅内术后血性脑脊液颅内压与乳酸水平对颅内感染的诊断价值

Diagnostic value of intracranial pressure and lactic acid in patients with postoperative intracranial infection

目的研究血性脑脊液中乳酸水平与颅内压在术后颅内感染的诊断价值。方法选取铜陵市人民医院神经外科2020年1月-2022年3月收治的35例行脑室钻孔引流术和颅内压探头置入的脑室出血(继发性和原发性脑室出血)患者为研究对象,分为感染组19例,非感染组16例,对患者血性脑脊液中颅内压及脑脊液乳酸进行回顾性分析。结果感染组的血性脑脊液乳酸水平6.0(2.0)mmol/L大于非感染组的2.4(1.7)mmol/L,差异有统计学意义(Z=-4.525,P<0.001);感染组的颅内压值11.0(9.0)mmHg和非感染组11.0(9.0)mmHg差异无统计学意义(Z=-0.117,P=0.907)。在相关性检验中,乳酸水平和颅内压在感染组、非感染组和不分组下差异均无统计学意义(P=0.477、0.328、0.845)。受试者工作特征(ROC)曲线显示血性脑脊液中乳酸水平对颅内感染有诊断价值,ROC曲线下面积为94.9%,乳酸3.8 mmol/L为颅内感染临界值。结论在行脑室钻孔引流和颅内压探头置入的脑室出血患者中,血性脑脊液中颅内压对于颅内感染无诊断价值,乳酸对感染有诊断价值。

Objective To evaluate the diagnostic value and correlation of lactic acid(LA)and intracranial pressure(ICP)in bloody cerebrospinal fluid(BCSF)for intracranial infection.Methods 35 patients underwent external lateral ventriculardrainage(ELVD)and ICP monitoring insertion from January 2020 to March 2022 in Department of Neurosurgery,TonglingPeople’s Hospital were selected and divided into infected group(19 cases)and non-infected group(16 cases).Intracranialpressure of the patients was recorded and lactic acid from bloody cerebrospinal fluid gathered by lumbar puncture and wasexamined.A retrospective analysis was studied about the datum.Results The lactate level of the infected group 6.0(2.0)mmol/L was higher than that of the non-infected group 2.4(1.7)mmol/L.The difference was statistically significant(Z=-4.525,P<0.001).There was no statistical significance(Z=-0.117,P=0.907)between the value of intracranialpressure from the infected group 11.0(9.0)mm Hg and that from the non-infected group 11.0(9.0)mm Hg.There was nostatistical significance for correlation between the level of lactate and the value of intracranial pressure in the infected group(P=0.477),the non-infeted group(P=0.328)or no grouping(P=0.845).Receiver operating characteristic(ROC)curveanalysis showed that LA in BCSF owned the diagnostic value for intracranial infection.The area under ROC curve was94.9%.The cutoff value of lactate was 3.8 mmol/L.ConclusionIn this study,patients of intraventricular hemorrhage withpost-operative neurosurgery of ELVD and ICP monitoring insertion,the level of BCSF lactate,but not the level of ICP haddiagnostic value for intracranial infection.