重型颅脑损伤合并肺部感染血清PCT、CRP、IL-6水平的变化及病原菌、耐药状况分析

Changes of Serum PCT, CRP and IL-6 Levels in Patients with Severe Craniocerebral Injury Complicated with Pulmonary Infection and Analysis of Pathogenic Bacteria and Drug Resistance

目的:探讨重型颅脑损伤合并肺部感染患者血清降钙素原、C反应蛋白及白细胞介素-6水平的变化,对肺部感染的病原菌分布及耐药情况进行调查总结。方法:将ICU于2019年1月~2020年12月收治的80例重型颅脑损伤合并肺部感染的患者纳入观察组,同期未合并肺部感染的80例重型颅脑损伤患者纳入对照组,比较两组患者血清降钙素原、C反应蛋白及白细胞介素-6水平的变化,取深部痰液进行病原菌配药及药敏试验。结果:在入院第3天、第5天,观察组患者血清降钙素原、C反应蛋白及白细胞介素-6水平均明显高于对照组,差异均有显著性(P<0.05);病原菌以革兰阴性菌最常见,占62.50%,尤其以鲍曼不动杆菌最多见,占23.75%;革兰阳性菌占27.50%;真菌8株,占10.00%;革兰阴性菌仅对头孢哌酮/舒巴坦、亚胺培南较敏感,对头孢唑林、氨苄西林等药物耐药率>80.00%;革兰阳性菌对万古霉素、替考拉宁敏感性高,对其他常见的抗菌药物存在普遍耐药。结论:重型颅脑损伤合并肺部感染患者血清降钙素原、C反应蛋白及白细胞介素-6水平均增高明显,可作为早期诊断肺部感染的有效指标;重型颅脑损伤合并肺部感染以革兰阴性菌最为常见,且病原菌的耐药情况均较为严重。

Objective: To discuss the changes of serum PCT, CRP and IL-6 levels in patients with severe head injury complicated with pulmonary infection, and to investigate and summarized the distribution of pathogenic bacteria and drug resistance of pulmonary infection. Methods: 80 patients with SHI complicated with pulmonary infection in ICU from January 2019 to December 2020 were included into the observation group, and 80 patients without pulmonary infection were included into the control group. The changes of serum PCT, CRP and IL-6 were compared between the two groups, and the deep sputum was taken for pathogenic bacteria dispensing and drug sensitivity test. Results: On the 3 rd and 5 th day after admission, the serum PCT, CRP and IL-6 in the observation group were significantly higher than those in the control group. And difference between the two groups was statistically significant(P<0.05);the most common pathogens were gram negative bacteria(62.50%), especially Acinetobacter baumannii(23.75%), and gram positive bacteria(27.50%), 8 fungi strains(10.00%);Gram negative bacteria were only sensitive to Cefoperazone/sulbactam, imipenem, and more than80.00% of them were resistant to cefazolin and ampicillin;gram positive bacteria were highly sensitive to vancomycin and teicoplanin,and generally resistant to other common antibiotics. Conclusion: The levels of serum PCT, CRP and IL-6 in patients with SHI complicated with pulmonary infection are significantly increased, which can be used as an effective indicator for early diagnosis of pulmonary infection;Gram negative bacteria are the most common in patients with SHI complicated with pulmonary infection, and the drug resistance of pathogenic bacteria is severe.