脑脊液中乳酸水平对开颅患者诱发感染和短期预后的影响

Effects of lactate levels in cerebrospinal fluid on induced infection and short-term prognosis in patients with craniotomy

目的探讨脑脊液中乳酸水平对开颅患者诱发感染和短期预后的影响。方法选择2016年6月至2018年12月于我院行开颅手术后颅内感染的患者38例为观察组,非颅内感染患者30例为对照组。术后24~48 h内采集脑脊液标本,检测脑脊液的乳酸、葡萄糖、氯化物、白细胞计数和多核细胞百分比。按照格拉斯哥昏迷评分将观察组颅内感染患者分为轻、中、重症型三组,比较三组脑脊液乳酸水平。将观察组患者分为预后良好和预后不良两组,比较两组脑脊液乳酸水平。结果观察组脑脊液中白细胞计数、多核细胞百分比和乳酸浓度均显著高于对照组;葡萄糖和氯化物浓度均显著低于对照组(P<0.05)。轻症型组、中症型组以及重症型组脑脊液乳酸水平依次为(6.51±0.78)mmol/L、(8.99±0.65)mmol/L和(10.35±0.91)mmol/L,差异有统计学意义(P<0.05)。ROC曲线结果显示,脑脊液乳酸对开颅患者颅内感染的预后价值最高,其曲线下面积为0.813,高于其他生化检查指标。预后良好组脑脊液乳酸水平为(3.17±0.83)mmol/L,明显低于预后不良组的(4.03±0.76)mmol/L(P<0.05)。结论脑脊液中乳酸含量在开颅手术后颅内感染的发生有良好的预测价值,可作为颅内感染及其严重程度的诊断指标,为临床上的治疗提供一定参考。

Objective To investigate effects of lactate levels in cerebrospinal fluid(CSF)on induced infection and short-term prognosis in patients with craniotomy.Methods A total of 38 cases with intracranial infection after craniotomy in our hospital from June 2016 to December 2018 were selected as the observation group and 30 cases without intracranial infection were selected as the control group.CSF samples were collected within 24-48 hours postoperatively.Lactic acid,glucose,chloride,white blood cell(WBC)count and percentage of polynuclear cells were detected in CSF.According to Glasgow Coma Scale(GCS),patients with intracranial infection were divided into mild,moderate and severe group,and lactate levels in CSF were compared between three groups.Patients in observation group were divided into two groups:Good prognosis group and poor prognosis group.Lactic acid levels in CSF were compared between two groups.Results WBC count,percentage of polynuclear cells and lactic acid concentration in CSF in the observation group were significantly higher than those in control group,while glucose and chloride concentrations were significantly lower than those in the control group(P<0.05).Serum lactate levels in mild group,moderate group and severe group were(6.51±0.78)mmol/L,(8.99±0.65)mmol/L and(10.35±0.91)mmol/L,respectively,with statistically significant differences(P<0.05).ROC curve showed that lactate levels in CSF had the highest prognostic value for intracranial infection in craniotomy patients whose area below curve was 0.813,higher than other biochemical indexes.Serum lactate level in patients with good prognosis was(3.17±0.83)mmol/L,which was significantly lower than that of(4.03±0.76)mmol/L in poor prognosis group(P<0.05).Conclusion Lactate levels in CSF has good predictive value for intracranial infection after craniotomy and it is a good diagnostic index for intracranial infection and severity of intracranial infection which provides a reference for clinical treatment.