ICU脑出血颅脑术后患者颅内感染的诊断及预后相关性分析

Diagnosis of postoperative intracranial infection in ICU cerebral hemorrhage patients undergoing brain surgery and correlative analysis of prognosis

目的对ICU脑出血颅脑术后患者颅内感染的诊断及预后相关性进行分析。方法选择2013年7月-2017年2月医院ICU脑出血颅脑术后治疗的患者182例。依据患者术后是否发生颅内感染分为感染组和非感染组,采集患者相关标本对其两组患者治疗前及治疗第1d、2d、3d、5d、7d、9d、12d的体温和相关指标进行监测。结果两组患者体温比较,感染组高于非感染组(P<0.05);治疗前感染组患者在C-反应蛋白(CRP)、降钙素原(PCT)、人基质金属蛋白酶-9(MMP-9)及白细胞(WBC)计数上要明显高于非感染组(P<0.05);感染组患者在给予相关治疗后CRP、PCT及MMP-9的水平呈现明显下降趋势(P<0.05);CRP诊断颅内感染的灵敏度为86.08%、特异度为79.75%,PCT分别为91.14%和87.34%,MMP-9分别为88.61%和87.34%,PCT联合MMP-9分别为97.47%和96.20%,PCT+CRP+MMP-9分别为98.73%和97.47%,差异具有统计学意义(P<0.05)。结论 PCT、CRP及MMP-9对于脑出血后颅脑感染可进行有效的临床诊断,其水平表达在一定程度上影响着患者的预后,因此尽早的对脑出血患者进行PCT、CRP及MMP-9的联合监测,对于术后患者发生颅内感染早期诊断及指导临床用药有着重要意义。

OBJECTIVE To analyze the diagnosis of postoperative intracranial infection in ICU cerebral hemorrhage patients undergoing brain surgery and the influencing factors for prognosis.METHODS A total of 182 patients with cerebral hemorrhage who underwent brain surgery from Jul 2013 to Feb 2017 were enrolled in the study and divided into the infection group and the non-infection group according to the status of postoperative intracranial infection.The specimens were collected from the patients,and the body temperature and related indexes were monitored before the treatment and after the treatment for 1,2,3,5,7,9 and 12 days.RESULTS The body temperature of the infection group was sighificantly higher than that of the non-infection group(P<0.05).The levels of C-reactive protein(CRP),procalcitonin(PCT),matrix metalloproteinase-9(MMP-9)and white blood cell(WBC)were sighificantly higher in the infection group than in the non-infection group before the treatment(P<0.05).The levels of CRP,PCT and MMP-9 of the infection group were significantly reduced after the related treatment(P<0.05).The sensitivity of the CRP was 86.08%in the diagnosis of intracranial infection,the specificity 79.75%;the sensitivity of the PCT was 91.14%,the specificity 87.34%;the sensitivity of the MMP-9 was88.61%,the specificity 87.34%;the sensitivity of the PCT combined with MMP-9 was 97.47%,the specificity96.20%;the sensitivity of the PCT plus CRP plus MMP-9 was 98.73%,the specificity 97.47%;there were significant differences(P<0.05).CONCLUSIONThe PCT,CRP and MMP-9 are effective for the diagnosis of postoperative intracranial infection in the patients with cerebral hemorrhage,which may influence the prognosis of the patients.The joint monitoring of PCT,CRP and MMP-9 has great significance in the early diagnosis of the cerebral hemorrhage patients with postoperative intracranid infection and provides guidance for clinical use of antibiotics.