弥漫性脑损伤合并肺部感染患者神经损伤及炎症因子的变化观察

Nerve injury and changes of inflammatory factors in diffuse brain injury patients complicated with pulmonary infections

目的分析弥漫性脑损伤合并肺部感染患者神经损伤及炎症介质因子指标的变化,为临床治疗提供指导依据。方法选取2014年1月-2016年1月医院收治的弥漫性脑损伤患者66例为研究对象,针对患者的临床感染情况、炎症因子指标水平、感染病原菌及药敏情况进行统计分析。结果 66例弥漫性脑损伤患者中,发生感染25例,感染率为37.88%;感染患者和非感染患者的神经细丝酸性蛋白、肌酸激酶同工酶和髓鞘碱性蛋白等神经损伤指标差异无统计学意义;感染患者的C-反应蛋白(CRP)、白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子α(TNF-α)、白介素-1(IL-1)水平分别为(40.87±5.34)mg/L、(337.24±23.45)pg/ml、(540.83±46.93)pg/ml、(95.92±8.62)pg/ml和(0.99±0.11)ng/L,均高于非感染患者的(30.82±3.57)mg/L、(259.45±16.83)pg/ml、(469.74±44.83)pg/ml、(84.44±7.45)pg/ml和(0.31±0.01)ng/L,且差异有统计学意义(P<0.01);25例感染患者共分离出病原菌30株,其中革兰阴性菌21株、革兰阳性菌8株、真菌1株,分别占70.00%、26.67%和3.33%;革兰阴性菌对氨曲南和亚胺培南的敏感度高,对氨苄西林、哌拉西林、头孢噻肟和头孢曲松等耐药性高,革兰阳性菌对青霉素和庆大霉素的耐药性高,对利福平的敏感度高。结论弥漫性脑损伤合并肺部感染患者的神经损伤情况较未感染患者差异不大,但其炎症因子水平显著升高,同时导致患者感染的病原菌以革兰阴性菌为主,临床治疗应根据药敏结果采取敏感的抗菌药实施针对性治疗。

OBJECTIVE To investigate the nerve injuries in diffuse brain injury patients complicated with pulmonary infections and observe the changes of levels of inflammatory factors so as to provide guidance for clinical treatment.METHODS A total of 66 patients with diffuse brain injury who were treated in hospitals from Jan 2014 to Jan 2016 were recruited as the study objects.The prevalence of clinical infections,levels of inflammatory factors,and distribution and drug susceptibility of pathogens causing the infections were statistically analyzed.RESULTS Of the 66 patients with diffuse brain injury,25 had the infections,with the infection rate 37.88%.There was no significant difference in the nerve injury indexes such as nerve filament acidic protein,creatine kinase isoenzymes,and myelin basic protein between the infection group and the non-infection group.The levels of C-reactive protein （CRP）,interleukin 6 （IL-6）,interleukin-8 （IL-8）,tumor necrosis factor （TNF-α）,and interleukin-1 （IL-1） of the patients with infection were respectively （40.87±k5.34）mg/L,（337.24±23.45）pg/ml,（540.83±46.93）pg/ml,（95.92±8.62）pg/ml,and （0.99±0.11）ng/L,significantly higher than （30.82t3.57）mg/L,（259.45± 16.83）pg/ml,（469.74±44.83）pg/ml,（84.44±7.45）pg/ml,and （0.31±0.01）ng/L of the patients without infection（P〈0.01）.Totally 30 strains of pathogens were isolated from the 25 patients with the infections,including 21 strains of gram-negative bacteria,8 strains of gram-positive bacteria,and 1 strain of fungus.The gram-negative bacteria were highly susceptible to aztroenam and imipenem but were highly resistant to ampicillin,piperacillin,cefotaxime,and ceftriaxone.The gram-positive bacteria were highly resistant to penicillin and gentamicin but were highly susceptible to rifampicin.CONCLUSION The status of nerve injury does not differ significantly from the diffuse brain injury patients complicated with pulmonary infections to the patients without the infections,however,the levels of inflammatory factors are remarkably elevated.The gram-negative bacteria are dominant among the pathogens causing the infections.It is necessary for the hospital to take targeted treatment measures and reasonably use antibiotics based on the result of drug susceptibility testing.