保护性通气法对颅内动脉瘤并蛛网膜下腔出血肺部感染患者介入术后病原菌分布及其炎症反应的研究

Effects of protective ventilation on pathogen distribution and inflammatory reaction in patients with pulmonary infection combined with subarachnoid hemorrhage caused by cerebral aneurysm

目的对颅内动脉瘤并蛛网膜下腔出血潜伏肺部感染患者介入术后病原菌分布及其血液炎症因子C-反应蛋白(CRP)和炎症细胞进行研究,为临床相关诊断和治疗提供参考。方法医院介入手术室2011年6月-2015年12月,实施全麻颅内动脉瘤并蛛血弹簧圈介入栓塞术患者120例,随机分成Ⅰ组、Ⅱ组、对照组(Ⅲ组),各60例;采用全自动微生物鉴定仪对分离的病原菌进行鉴定,分析患者感染后CRP和炎症细胞的变化。结果 60例感染患者共分离98株病原菌,以革兰阴性菌为主,共63株占64.3%;Ⅰ组、Ⅱ组、Ⅲ组炎症因子和炎症细胞反应因子进行比较,差异均有统计学意义(P<0.05)。结论颅内动脉瘤并蛛血患者术后病原菌感染以革兰阴性菌为主,且感染患者的炎症因子和炎症细胞含量与术前蛛网膜下腔出血评分(Hunt-Hess Scale)和全麻通气方式相关。

OBJECTIVE To explore the pathogen distribution and blood inflammatory factor C-reactive protein （CRP） and inflammatory cells in patients with pulmonary infection combined with subarachnoid hemorrhage caused by cerebral aneurysm, so as to provide references for clinical diagnosis and treatment. METHODS A total of 120 cases of infected subarachnoid hemorrhage patients caused by cerebral aneurysm in our hospital from Jun. 2011 to Dec. 2015 were enrolled in this investigation. Patients were randomly divided into group Ⅰ , group Ⅱ , and control group （group Ⅲ ）, with 60 cases in each group. The isolated pathogens were identified by BE） PHOE- NiX TM100 （USA） equipment, changes of CRP and inflammatory ceils after infection were analyzed. RESULTS Totally 98 stains of pathogens were identified from 60 infected patients, which were mainly 63 strains of gram- negative bacteria, accounting for 64.3 %, There were significant differences in inflammatory factors and inflamma- tory cell response factors among group Ⅰ , group Ⅱ and group Ⅲ （P〈0.05）. CONCLUSION Subarachnoid hem- orrhage patients caused by cerebral aneurysm are suffered from gram-negative bacteria, and the levels of inflamma- tory factors and inflammatory cells in infected patients were correlated with preoperative subarachnoid hemorrhage score （Hunt-Hess Scale） and general anesthesia method.