摘要
目的探究重症颅脑损伤术后呼吸机相关性肺炎(Ventilator-associated pneumonia,VAP)患者病原菌检测的意义及其降钙素原(Procalcitonin,PCT)、C-反应蛋白(C-reactive protein,CRP)、肺功能的变化。方法选取2017年5月-2019年5月于丽水市人民医院神经外科就诊的重症颅脑损伤术后VAP患者作感染组(40例),同期使用呼吸机未发生感染者作未感染组(40例),另选取同期健康体检者作对照组(80名)。所有患者均采取手术治疗,分别检测其病原菌及所有研究对象的PCT及CRP水平、肺功能。结果40例患者分离出病原菌52株,革兰阳性菌占48.08%,革兰阴性菌占50.00%,真菌仅占1.92%。感染组的PCT及CRP水平均高于未感染组、对照组,未感染组的PCT及CRP水平均高于对照组(P<0.05)。感染组的用力肺活量(Forced vital capacity,FVC)、一秒用力呼气容积(Forced expiratory volume in one second,FEV1)、FEV1/FVC、FEV1%水平均低于未感染组、对照组,未感染组的FEV1、FVC、FEV1/FVC、FEV1%水平均低于对照组(P<0.05)。结论重症颅脑损伤术后VAP患者感染病原菌包括革兰阳性菌、革兰阴性菌,且患者血清PCT、CRP水平呈高表达状态,肺功能下降明显,临床可检测血清PCT、CRP水平以评估重症颅脑损伤术后患者是否出现VAP。
OBJECTIVE To explore the distribution of pathogenic bacteria in patients with ventilator-associated pneumonia(VAP)after severe craniocerebral injury and the changes of procalcitonin(PCT),C-reactive protein(CRP)and lung function.METHODS Patients with VAP after severe craniocerebral injury treated in Department of Neurosurgery,Lishui Municipal People’s Hospital between May 2017 and May 2019 were enrolled as the infection group(40 cases).Patients who were not infected after ventilator during the same period were recruited as the uninfected group(40 cases),and 40 healthy persons during the same period were in the control group.All patients were treated with surgery.The levels of PCT,CRP and lung function and pathogenic bacteria in all subjects were detected respectively,and the diagnostic value of PCT and CRP for VAP was analyzed.RESULTS Fifty-two strains of pathogenic bacteria were isolated from 40 patients.Gram-positive bacteria accounted for 48.08%.Gram-negative bacteria accounted for 50.00%,and fungi accounted for only 1.92%.The levels of PCT and CRP in the infected group were significantly higher than that in the uninfected group and the control group,whereas the levels of PCT and CRP in the uninfected group were significantly higher than that in the control group(P<0.05).The levels of forced vital capacity(FVC),1 s forced expiratory volume(FEV1),FEV1/FVC and FEV1%in the infected group were significantly lower than that in the uninfected group and the control group,whereas the levels of FEV1,FVC,FEV1/FVC and FEV1%in the uninfected group were significantly lower than that in the control group(P<0.05).CONCLUSION Pathogenic bacteria in the VAP patients after severe craniocerebral injury surgery included gram-positive bacteria and gram-negative bacteria,and the levels of PCT and CRP in patients’serum were in a high expression state,and the pulmonary function decreased obviously.The levels of PCT and CRP in serum can be detected to predict whether VAP occured in patients after severe craniocerebral injury surgery
作者
陈琴芬
刘进
田达
陈君霞
张学磊
CHEN Qin-fen;LIU Jin;TIAN Da;CHEN Jun-xia;ZHANG Xue-lei(Lishui People's Hospital,Lishui,Zhejiang 323000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2020年第15期2335-2338,共4页
Chinese Journal of Nosocomiology
基金
浙江省医药卫生科技计划项目(2019PY018)。
关键词
重症颅脑损伤
呼吸机相关性肺炎
病原菌
降钙素原
C-反应蛋白
肺功能
Severe craniocerebral injury
Ventilator-associated pneumonia
Pathogenic bacteria
Procalcitonin
C-reactive protein
Lung function
