急性颅内出血后自主神经系统变化及易感性增加的研究  

Autonomic shift and increased susceptibility to infections after acute intracerebral hemorrhage

作　　者：程宏炜[1] 魏攀[1] 庄进学[1] 陈登奎[1] 陶传元[1] 薛峰[1] 李海龙[1] 张炜[1] 郑小强[1] 邓聪颖[1] 

机构地区：[1]解放军452医院神经外科,四川成都610021

出　　处：《四川医学》2012年第11期1925-1927,共3页Sichuan Medical Journal

摘　　要：目的急性脑卒中后的高感染率可能与脑组织介导的免疫抑制综合征相关。本次研究为探讨影响急性颅内出血后易感性增加的原因。方法回顾性分析了我院2009～2011年62例急性颅内出血的患者,以BRS(压力感受器反射敏感性)来评估自主神经系统变化。结果 36例(58%)的患者在入院后5d内出现了感染,感染患者均为显著的低BRS,高原始NIHSS评分,大出血量,血液脑室内扩散,接受侵入性操作。在多变量回归分析中,BRS降低(OR=0.54,95%CI 0.32～0.9,P=0.02)和侵入性操作(OR=2.32;95%CI,1.5～3.6;P<0.01)为颅内出血后感染的独立影响因子。结论BRS降低与颅内出血后的感染独立相关,自主神经系统变化可能在包括颅内出血的急性颅脑损伤后易感性的增加中起到了重要作用。侵入性操作会增加感染的发生率。Objective High infection rate after severe stroke may partly relate to brain-induced immunodepression syndrome.However,the underlying pathophysiology remains unclear.To investigate the role of autonomic shift in increased susceptibility to infection after acute intracerebral hemorrhage(ICH).Methods We retrospectively analyzed 62 selected patients with acute ICH from prospective database of our hospital in 2009~2011.Autonomic shift was assessed using the cross-correlational baroreflex sensitivity(BRS).Results We identified 36(58%) patients with infection during the first 5 days of hospital stay.Patients with infections had significantly lower BRS,higher initial NIHSS scores,larger hemorrhages,and more frequently had intraventricular blood extension and underwent invasive procedures.In the multivariate regression model,decreased BRS(OR,0.54;95% CI,0.32~0.91;P=0.02) and invasive procedures(OR,2.32;95% CI,1.5~3.6;P<0.001) remained independent predictors for an infection after ICH.Conclusion Decreased BRS was independently associated with infections after ICH.Autonomic shift may play an important role in increased susceptibility to infections after acute brain injury including ICH.The invasiveness would increase the occurrence of infection after ICH.

关 键 词：自主神经系统 压力感受器反射 颅内出血 感染 卒中 交感神经 

分 类 号：R651[医药卫生—外科学]