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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。
Objective To investigate the related factors affecting the clinical outcome of sepsis patients with neurological intensive care unit (NICU). Methods Twenty patients with sepsis in NICU were divided into survival group and death group according to clinical outcome. The age, primary disease, tracheal intubation / tracheostomy / ventilator use, timing of infection, location of infection, The pathological changes of the patients were observed. The levels of procalcitonin (PCT), C-reactive protein (CRP) and serum albumin (ALB) on the 1st, 3rd and 7th day of the course of the disease were detected and the NIH Stroke Scale NIHSS) and acute physiology and chronic health status (APACHE II) score, correlation analysis. Results The average age of 20 patients was (61.8 ± 20.7) years, the rate of assisted breathing was 65% and the average duration of use was (26.4 ± 23.6) days. The infection occurred at 3.0 ± 1.5 days after the onset of primary disease % Respiratory infections, 85% of strains Gram-negative bacilli. The PCT level of survivors increased first and then decreased within one week, the difference was statistically significant (P <0.05, P <0.01). In both groups, the level of CRP gradually increased with the course of disease (P <0.01, P <0.05). The level of ALB decreased with the course of disease (P <0.05, P <0.01). Correlation analysis showed that there was a positive correlation between NIHSS score and APACHEⅡscore within 1 week (r = 0.74, P <0.01; r = 0.52, P <0.05; r = 0.54, P <0.05) NIHSS score was positively correlated (r = 0.64, P <0.01), while ALB level was negatively correlated with APACHE II score (r = -0.47, P <0.05). Conclusion The changes of PCT, CRP, ALB, NIHSS and APACHEⅡ scores in early monitoring patients have important reference value for the prognosis and treatment decision of sepsis patients in NICU.