脑脊液和血清降钙素原对颅内压监测脑室导管留置时间的指导价值  

Guidance value of cerebrospinal fluid and serum procalcitonin in the ventricular catheter indwelling time of intracranial pressure monitoring

作　　者：余果[1] 王尔松[1] 姚慧斌[1] 费力[1] 

机构地区：[1]复旦大学附属金山医院神经外科,上海201508

出　　处：《中国综合临床》2017年第2期101-104,共4页Clinical Medicine of China

基　　金：上海市金山区卫生局面上项目、复旦大学附属医院资助项目（JSKJ-KTMS-2013-04）

摘　　要：目的探讨脑脊液和血清降钙素原（PCT）对颅内压监测脑室导管留置时间的指导价值。方法选择行脑室导管颅内压监测加引流治疗的中、重型颅脑外伤患者58例，分别于手术当时及术后第1、7、14天通过脑室导管收集脑脊液5 ml，同时抽取静脉血2 ml。比较不同时间脑脊液和血清PCT、WBC的变化，并分析各指标之间的相关性以及对颅内感染的诊断价值。结果随着脑室导管留置时间的延长，患者脑脊液PCT[手术时：（0.09±0.02） μg/L、术后第14天：（1.17±0.25） μg/L]和WBC[手术时：（24.33±12.75）×10^6/L、术后第14天：（431.52±140.26）×10^6/L ]，血清PCT[手术时：（0.16±0.05） μg/L]、术后第14天：（4.57±1.41） μg/L]和WBC[手术时：（4.14±0.46）×10^6/L、术后第14天：（14.24±3.05）×10^6/L]均呈现明显的升高趋势（P均〈0.05）；脑脊液PCT与脑脊液WBC、血清PCT均呈正相关（r值分别为0.614、0.711，P均〈0.05）；脑脊液和血清PCT对颅内感染的诊断价值：灵敏度分别为95.2%、81.0%，特异度分别为94.6%、78.4%，脑脊液PCT的特异度显著高于血清PCT（P＝0.041）。结论脑脊液和血清PCT对颅内压监测脑室导管患者颅内感染具有较高的早期诊断价值，有助于指导合理的拔除时机，最大限度发挥颅内压监测和脑脊液的引流作用，提高脑外伤患者的救治水平。ObjectiveTo explore the guidance value of cerebrospinal fluid（CSF） and serum procalcitonin（PCT） in the ventricular catheter indwelling time of intracranial pressure monitoring（ICP）.MethodsFifty-eight cases patients with moderate and severe craniocerebral trauma who were given ICP ventricular catheter and external ventricular drainage（EVD） were selected, 5 ml CSF and 2 ml venous blood were collected at operation, 1st, 7th, 14th d after operation.The change of CSF and serum PCT and WBC levels were compared among different time, the correlation among each indicators and diagnosis value for intracranial infection were analyzed.ResultsThe level of CSF and serum PCT and WBC increased with the lengthen of ventricular catheter indwelling time（CSF PCT： （0.09±0.02） μg/L of operation, （1.17±0.25） μg/L of 14 d after the operation; CSF WBC： （24.33±12.75）×106/L of operation, （431.52±140.26）×106/L of 14 d after the operation; serum PCT： （0.16±0.05） μg/L of operation, （4.57±1.41） μg/L of 14 d after the operation; serum WBC： （4.14±0.46）×106/L of operation, （14.24±3.05）×106/L of 14 d after the operation; P〈0.05）. The CSF PCT was positively correlated with CSF WBC and serum PCT（r=0.614, 0.711, P〈0.05）. The diagnostic sensitivity of CSF and serum PCT for prognosis of intracranial infection were 95.2%, 81.0%, the specificity were 94.6%, 78.4%, the specificity of CSF PCT was significantly higher than that of serum PCT（P=0.041）.ConclusionCSF and serum PCT has high early diagnosis value for intracranial infection in patients with ICP ventricular catheter, which can contribute to guide the reasonable timing of tube drawing, brings out the best of ICP and cerebrospinal fluid drainage, improve the level of treatment in patients with traumatic brain injury.

关 键 词：脑脊液 降钙素原 颅内压监测 颅内感染 

分 类 号：R651.15[医药卫生—外科学]