【摘要】 目的探讨影响神经重症监护室(NICU)的脓毒症患者临床结局的相关因素。方法 NICU中的脓毒症患者20例,依临床结局分为存活组和死亡组,比较其年龄、原发病、气管插管/气管切开/呼吸机使用、感染发生时机、感染部位和致病菌种;检测患者病程第1天、第3天和第7天的降钙素原(PCT)、C反应蛋白(CRP)和血清白蛋白(ALB)水平及国立卫生研究院卒中量表(NIHSS)和急性生理学及慢性健康状况(APACHEⅡ)的评分,进行相关性分析。结果 20例患者平均年龄为(61.8±20.7)岁,辅助呼吸使用率65%,平均使用时间为(26.4±23.6)d;感染发生于原发病发病后(3.0±1.5)d,感染部位90%位于呼吸系统感染,菌种85%为革兰氏阴性杆菌。存活组的PCT水平1周内呈先升后降的变化,差异有统计学意义(P<0.05,P<0.01)。两组中,CRP水平随病程而逐渐上升(P<0.01,P<0.05);ALB水平则随病程而明显下降(P<0.05,P<0.01)。相关性分析显示,病程1周内的NIHSS评分与APACHEⅡ评分呈正相关(r=0.74,P<0.01;r=0.52,P<0.05;r=0.54,P<0.05),第7天的CRP水平与NIHSS评分均呈正相关(r=0.64,P<0.01)而ALB水平则与APACHEⅡ评分呈负相关(r=-0.47,P<0.05)。结论早期监测患者的PCT、CRP、ALB、NIHSS及APACHEⅡ评分的变化,对NICU的脓毒症患者的预后判断和治疗决策有重要参考意义。更多还原

【Abstract】 Objective To explore the clinical factors that possibly affect the clinical outcomes of sepsis patients cared in neurological intensive care unit( NICU). Methods Twenty patients with sepsis in NICU were divided into the survival group and the death group according to their outcomes,their clinical data were compared such as age,primary diseases,rates of endotracheal intubation /tracheotomy and use of ventilator,the mean time interval between onset of primary disease and infection,the infection sites,and pathogenic bacteria. Also,in the day 1,day 3,and day 7 of the infection,measuring their levels of C-reactive protein( CRP),procalcitonin( PCT),and serum albumin( ALB) as well as their scores of NIHSS and Acute Physiology and Chronic Health Evaluation Ⅱ( APACHEⅡ).Relevant analysis were done for these measurements between two groups. Results The mean age of the 20 patients was 61. 8 ± 20. 7 years. The rate of tracheal intubation / and use of ventilator was 65%,and the average time of usage was 26. 4 ± 23. 6 days. Infections occurred averagely 3 days after the onset of primary diseases,90% of them were respiratory system infection,and 85% of the pathogens were gram-negative bacillus. In the survival group,the level of PCT was rose first and then fallen( P < 0. 05,P < 0. 01). The both groups,the levels of CRP increased and the levels of ALB decreased gradually during the infection course. Relevant analysis showed that the scores of NIHSS and APACHEⅡ positively correlated in the day 1,day 3,and day 7( r = 0. 74,P < 0. 01; r = 0. 52,P < 0. 05; r =0. 54,P < 0. 05). In the day 7,the CRP levels positively correlated with NIHSS scores( r = 0. 64,P < 0. 01) and the ALB levels negatively correlated with APACHE Ⅱ scores( r =- 0. 47,P < 0. 05). Conclusion Early and dynamic measurements of PCT,CRP,ALB,NIHSS and APACHE Ⅱ are important for early clinical outcome prediction and treatment decision in patients with sepsis cared in NICU.更多还原