神经外科颅脑术后伴手术部位感染患者神经功能及脑氧代谢指标的变化

Changes of neurological function and cerebral oxygen metabolism indicators of neurosurgery department patients complicated with surgical site infections after brain surgery

目的探讨神经外科颅脑术后伴手术部位感染患者神经功能及脑氧代谢指标的变化情况,为神经外科颅脑患者术后感染的预防及相关研究提供参考。方法选取医院2010年12月-2011年12月临床收治的神经外科颅脑手术患者68例,根据患者术后是否并发手术部位感染分为感染组和非感染组,各34例,比较两组患者的特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)和S100B蛋白(S100B)等神经功能指标和颈内静脉血乳酸(JVL)、颈静脉血氧饱和度(SjvO2)、动脉颈静脉血氧含量差(A-vDD2)和脑氧摄取率(CERO2)等脑氧代谢指标。结果感染组患者的NSE、MBP和S100B分别为(22.34±2.14)ng/L、(1.74±0.19)ng/ml和(1.98±0.31)ng/L,显著高于非感染组,差异有统计学意义(P<0.01);感染组患者的JVL、SjvO2、A-vDD2和CERO2分别为(3.88±0.33)mmol/L、(53.23±6.43)%、(70.34±11.24)ml/L和(48.32±6.83)%,优于非感染组,差异有统计学意义(P<0.01)。结论手术部位感染可导致神经外科颅脑术后患者的神经功能指标的高浓度表达和脑氧代谢指标的改变,针对于患者术后神经功能指标和脑氧代谢指标的监测可对患者术后感染情况进行预测和判断。

OBJECTIVE To explore the changes of neurological function and cerebral oxygen metabolism indicators of neurosurgery department patients complicated with surgical site infections after brain surgery so as to provide guidance for prevention of the postoperative infections and related researches.METHODS A total of 68 patients who underwent the brain surgery in department of neurosurgery from Dec 2010 to Dec 2011 were enrolled in the study and divided into the infection group and the non-infection group according to the status of complication with postoperative surgical site infections,with 34 cases in each group.The neurological function indicators such as neuron-specific enolase（NSE）,myelin basic protein（MBP）,and S100Bprotein（S100B）as well as the cerebral oxygen metabolism indicators such as jugular venous lactate（JVL）,jugular venous oxygen saturation（SjvO2）,arterial jugular venous oxygen content difference（A-vDD2）,and cerebral oxygen extraction rate（CERO2）were observed and compared between the two groups of patients.RESULTS The levels of NSE,MBP,and S100 Bof the infection group were respectively（22.34±2.14）ng/L,（1.74±0.19）ng/ml,and（1.98±0.31）ng/L,significantly higher those of the non-infection group（P〈0.01）.The JVL,SjvO2,A-vDD2,and CERO2 of the infection group were respectively（3.88±0.33）mmol/L,（53.23±6.43）%,（70.34±11.24）ml/L,and（48.32±6.83）%,significantly better than those of the non-infection group（P〈0.01）.CONCLUSION The surgical site infections may lead to the high-concentration expression of neurological function indicators and the changes of cerebral oxygen metabolism indicators of the neurosurgery department patients after the brain surgery.The monitoring of the neurological function and cerebral oxygen metabolism indicators can facilitate the prediction and judgment of status of the postoperative infections.