基层医院颅脑手术术后颅内感染的早期诊断方法分析  

Early diagnosis of patients complicated with ventriculitis after cerebral surgery in one primary hospital

作　　者：陈兰春[1] 李展汉 唐玮欣 余雪涛[1] CHEN Lan-chun;LI Zhang-han;TANG Wei-xin;YU Xue-tao(Intensive Care Unit of Longgan District people's Hospital of Shenzhen, Shenzhen, Guangdong 518172)

机构地区：[1]深圳市龙岗区人民医院重症医学科

出　　处：《赣南医学院学报》2019年第5期493-495,499,共4页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：目的:了解基层医院颅脑手术术后颅内感染患者早期诊治现状。方法:回顾分析23例颅脑手术术后颅内感染患者的临床资料,记录怀疑颅内感染48小时内患者的意识状态评分(格拉氏哥评分)、外周血白细胞计数、C-反应蛋白、血浆PCT结果,以及患者脑脊液常规、生化及微生物鉴定结果并进行分析。结果:23例患者平均年龄(52±14)岁,血白细胞计数(15.75±5.65)×10^9·L^-1,C反应蛋白水平(127.78±29.95)mg·L^-1,血浆PCT(0.49±0.43)ng·m L^-1。23例患者7例微生物鉴定结果阳性,其中4例脑脊液微生物培养阳性,3例脑脊液病原体二代测序技术检测到微生物基因序列。1例临床诊断颅内感染患者,脑脊液病原体二代测序未检测到微生物基因序列。23例患者外周血白细胞计数与C反应蛋白均明显升高,但血浆PCT升高幅度不大。结论:目前颅脑手术术后并发颅内感染的早期诊断仍然依靠传统方法,血浆PCT作为新型的感染指标用于颅脑手术术后颅内早期感染的诊断指标作用有限。未来脑脊液病原体二代测序技术的应用是否可提高颅内手术术后感染早期诊断率,指导临床医师用药治疗,改善此类患者的预后还需大量的研究证实。Objective: To learn the early dianostic methods in patients complicated with ventriculitis after cerebral surgery in one primary hospital. Methods: 23 patients complicated with ventriculitis after cerebral surgery were retrospectively studied. The patients' concious level, white cell counts(WBC), C-reative protein(CRP), procalcitonin(PCT), routine examinations of cerebrospinal fluid(CSF) and indentification of microorganisms were recorded in patients who were suspected with ventriculitis within 48 hours.The results were analyzed by SPSS 17.0. Results: The patients' average age, WBC, CRP, PCT were of (52 ±14) years old,(15.75±5.65)×10^ 9·L ^-1 ,(127.78±29.95) mg·L ^-1 and (0.49± 0.43 ) ng·mL ^-1 respectively. Microorganism culture results were positive in only seven patients, 4 by routine CSF culture and 3 by next generation sequencing technology.In all patients, the WBC and CRP were significantly increased, and the PCT was not. Conclusions: The diagnosis of ventriculitis after cerebral surgery was still based on traditional methods. PCT was limited in the dianosis of ventriculitis. Whether the next generation sequencing technology could be used to early diagnose ventriculitis still needs more clincal trials.

关 键 词：颅内感染 降钙素原 早期诊断 病原体二代测序 

分 类 号：R619.3[医药卫生—外科学]