重型颅脑损伤应激反应与早期感染的鉴别  

Differention of stress response and early infection in severe craniocerebral injury

作　　者：许毅[1] 刘科[1] 胡曦[1] 邓永兵[1] 肖虹[1] 

机构地区：[1]重庆市急救医疗中心神经外科,重庆400014

出　　处：《创伤外科杂志》2013年第3期237-239,共3页Journal of Traumatic Surgery

基　　金：重庆市医疗特色专科资助项目（渝卫科教2010-52）

摘　　要：目的研究重型颅脑损伤应激反应与早期感染的异同,并探讨全身炎症反应综合征修正评分对早期感染的预测价值。方法对105例重型颅脑损伤患者,采集伤后1周内体温及白细胞(WBC)变化情况,分析应激反应及早期感染的特点;并对患者进行全身炎症反应综合征修正评分(ASS),运用受试者特征曲线(receiver operating characteristiccurve,ROC曲线)评价ASS评分对早期感染的预测价值。结果应激反应导致的体温及白细胞异常以伤后第1天最明显,以后呈下降趋势,感染者下降后会再次上升;感染组与非感染组ASS评分有显著差异(t=10.163,P=0.000),ROC曲线提示ASS评分对早期感染有预测价值(AUC=0.954),其中ASS评分>7.5分时感染可能性大。结论体温及白细胞走势对早期感染更具有指示意义,ASS评分对早期感染有预测价值,可以帮助鉴别应激反应与早期感染。Objective To study the similarities and differences of stress response and early infection in se- vere craniocerebral injury and to discuss the value of the adjusted score of SIRS （ ASS score ） in predicting early in- fection. Methods Among the 105 severely craniocerebral injury patients, the changes of temperature and white blood cells （ WBC ） within a week after injury were observed, characteristics of stress response and early infection were observed; ASS score was used for statistical analysis of the patients and receiver operating characteristic curve （ROC curve） was used to evaluate the predictive value about ASS in early infection. Results The most unusual changes of temperature and white blood cells on account of stress response happened on the first day and then de- scended, but the temperature and white blood cells of the infected patients rised once again. ASS score showed sig- nificant difference between infection group and non-infection group（ t = 10. 163 ,P =0. 000）. ROC curve suggested that ASS score had good calibration for predicting early infection in patients with severe craniocerebral injury（ AUC = 0. 954 ）, and infection was likely to occur when ASS score was more than 7.5. Conclusion The trend of temper- ature and white blood cells has more important value for early infection and ASS score also has good calibration for predicting early infection, which can help doctors distinguish stress response and early infection.

关 键 词：颅脑损伤 感染 应激反应 炎症 评分 

分 类 号：R651.1[医药卫生—外科学]