血清PCT与CRP在脑卒中昏迷患者留置口咽通气道胃管合并肺部感染中的临床价值探讨

Detection and analysis of PCT and CRP in patients with pulmonary infection caused by indwelling oropharyngeal airway and gastric tube in coma after stroke

目的:研究血清PCT(降钙素原)、CRP(C反应蛋白)在脑卒中昏迷患者留置口咽通气道胃管合并肺部感染中的临床价值,为患者的临床诊疗提供指导。方法:选取2016年6月~2017年6月接诊的202例脑卒中昏迷患者留置口咽通气道胃管患者进行研究。根据患者是否发生肺部感染,分为感染组(n=82)和未感染组(n=120)。对患者的各项资料进行汇总分析,并对PCT、CRP水平及病原菌感染状况进行检测分析。结果:感染组患者血清PCT、CRP水平均明显高于非感染组,两组比较有统计学意义。通过对留置口咽通气道胃管发生肺部感染的单因素分析发现,气管切开时间、白蛋白水平、GCS评分、激素使用、预防性抗菌药物应用、留置胃管时间及有糖尿病病史均与留置口咽通气道胃管发生肺部感染有关。多因素Logistic回归分析结果显示,气管切开时间、GCS评分、激素使用、胃管留置时间及糖尿病病史是留置口咽通气道胃管发生肺部感染的独立危险因素。在对肺部感染患者病原菌分析中发现,共检测出病原菌322株。G-菌感染株数最多,占71.11%,其中以铜绿假单胞菌最高,占25.78%,肺炎克雷伯菌次之,占21.42%;G+菌感染株数占28.88%,其中以金黄色葡萄球菌感染株数最多,占9.94%。结论:气管切开时间、GCS评分、激素使用、胃管留置时间及糖尿病病史是脑卒中昏迷患者留置口咽通气道胃管发生肺部感染的独立危险因素,在临床中应加以预防。患者PCT、CRP水平会明显升高,感染的病原菌以G-菌为主,可以针对性进行抗菌药物选择。

Objective To study the clinical value of serum PCT(procalcitonin)and CRP(C-reactive protein)in patients with cerebral apoplexy coma who have left oropharyngeal airway and gastric tube with pulmonary infection,so as to provide guidance for clinical diagnosis and treatment.Methods 202 patients with cerebral apoplexy coma who were admitted from June 2016 to June 2017 were selected to study the effect of indwelling oropharyngeal airway and gastric tube.The patients were divided into infection group(n=82)and uninfected group(n=120)according to whether they had pulmonary infection or not.The data of patients were collected and analyzed,and PCT,CRP levels and pathogenic bacteria infection were detected and analyzed.Results The levels of CT and CRP in the infected group were significantly higher than those in the non-infected group,with statistical significance between the two groups.The univariate analysis showed that tracheotomy time,albumin level,GCS score,hormone use,prophylactic antibiotics use,indwelling gastric tube time and diabetes history were all related to the occurrence of pulmonary infection in indwelling oropharyngeal airway gastric tube.Multivariate logistic regression analysis showed that tracheotomy time,GCS score,hormone use,indwelling time of gastric tube and diabetes history were independent risk factors for pulmonary infection in indwelling oropharyngeal airway and gastric tube.A total of 322 strains of pathogenic bacteria were detected in the analysis of pathogenic bacteria in patients with pulmonary infection.G-bacteria accounted for 71.11%.Pseudomonas aeruginosa accounted for 25.78%.Klebsiella pneumoniae accounted for 21.42%,G+bacteria accounted for 28.88%.Staphylococcus aureus accounted for 9.94%.Conclusion Tracheotomy time,GCS score,hormone use,indwelling time of gastric tube and diabetic history are independent risk factors for pulmonary infection in patients with stroke coma.The levels of PCT and CRP in patients will increase significantly,G-bacteria are the main pathogens of infection,and antimicrobial agents can be selected according to their specific needs.