重型颅脑损伤患者术后继发颅内感染的危险因素及血清PCT、CRP的预测价值

Risk factors of postoperative infection and predictive value of serum PCT and CRP in patients with severe craniocerebral injury

目的探讨重型颅脑损伤患者术后继发颅内感染的危险因素及血清降钙素原(PCT)、C反应蛋白(CRP)的预测价值。方法选取2017年1月-2019年11月于苏州大学附属张家港医院接受手术治疗的50例重型颅脑损伤患者作为研究对象,根据感染情况分为非感染组(n=28)和颅内感染组(n=22),分析术后继发颅内感染的因素,并使用Logistics回归分析对高危因素进行分析。比较感染组和非感染组PCT、CRP水平,使用受试者工作特征(ROC)曲线分析血清PCT、CRP水平对重型颅脑损伤患者术后继发感染的预测价值。结果两组年龄、术前格拉斯哥昏迷评分(GCS)、手术时间、低蛋白血症、脑室外引流、气管插管或切开、广谱抗生素使用时间比较,差异均有统计学意义(P<0.05)。多因素Logistics回归分析显示,年龄≥60岁、术前GCS评分<8分、手术时间≥4 h、低蛋白血症、脑室外引流、气管插管或切开、使用广谱抗生素时间≥14 d是重型颅脑损伤患者术后继发颅内感染的危险因素;感染组PCT、CRP水平均高于非感染组(P<0.05)。ROC曲线分析结果显示,PCT联合CRP检测的AUC高于PCT、CRP单独检测(P<0.05)。结论年龄、术前GCS评分、手术时间、低蛋白血症、脑室外引流、气管插管或切开、广谱抗生素使用时间是重型颅脑损伤患者术后继发颅内感染的影响因素,血清PCT、CRP水平对重型颅脑损伤患者术后继发颅内感染有较好的预测价值。

Objective To explore risk factors of postoperative infection and predictive value of serum procalcitonin(PCT)and C-reactive protein(CRP) in patients with severe craniocerebral injury(SCI).Methods Fifty SCI patients who underwent surgery in the hospital from January 2017 to November 2019 were enrolled as study objects.According to different infection situations,they were divided into non-infection group(n=28) and infection group(n=22).The postoperative infection factors were analyzed.Logistic retrospective analysis was applied in high-risk factors.PCT and CRP levels were compared between infection group and noninfection group.The predictive value of serum PCT and CRP levels in postoperative infection of SCI patients was analyzed by receiver operating characteristic(ROC) curves.Results There were significant differences in age,preoperative score of Glasgow Coma Scale(GCS),operation time,hypoalbuminemia,external ventricular drainage(EVD),tracheal intubation or incision and usage time of antibacterials between the two groups(P<0.05).The results of multivariate analysis showed that age not lower than 60 years old,preoperative GCS score lower than 8 points,operative time not shorter than 4 h,hypoproteinemia,EVD,tracheal intubation or incision,and antibacterial usage time not shorter than 14 d were risk factors of preoperative infection in SCI patients.PCT and CRP levels in infection group were higher than those in non-infection group(P<0.05).The results of ROCcurve analysis showed that AUC of PCT combined with CRP was higher than that of PCT and CRP alone(P<0.05).Conclusions Age,preoperative GCS score,operation time,hypoalbuminemia,EVD,tracheal intubation or incision and usage time of antibacterials were influencing factors of preoperative infection in SCI patients.Serum PCT and CRP levels had good predictive value for preoperative infection in SCI patients.