目的 分析动态监测重型颅脑损伤术后患者血清降钙素原(PCT)、可溶性髓样细胞表达的激发受体-1(sTREM-1)及C反应蛋白与白蛋白比值(CRP/ALB)的变化对肺部感染的早期预测价值.方法 选取手术治疗的196例重型颅脑损伤患者,监测并记录术后1、3、5d的血清PCT、CRP、ALB、sTREM-1及CRP/ALB水平,记录患者术后肺部感染情况.分析重型颅脑损伤术后肺部感染的危险因素,通过绘制受试者工作特征(ROC)曲线分析相关指标对肺部感染的早期预测价值.结果 重型颅脑损伤术后发生肺部感染者76例(38.78％),感染发生时间为术后6-13 d,中位数为7d.无肺部感染组术后3、5d血清PCT、sTREM-1及CRP/ALB低于肺部感染组,差异有统计学意义(P＜0.05);肺部感染组术后5d血清ALB低于无肺部感染组,差异有统计学意义(P＜0.05).机械通气时间、术后格拉斯哥昏迷量表(GCS)评分、术后急性生理与慢性健康评分Ⅱ(APACHEⅡ)以及术后5d血清PCT、sTREM-1及CRP/ALB是术后肺部感染的独立危险因素(P＜0.05).ROC曲线显示,单独检测时,术后5d血清CRP/ALB预测肺部感染的曲线下面积(AUC)值、约登指数、特异度最高,sTREM-1预测的敏感度最高;联合检测的AUC、约登指数、灵敏度、特异度均高于单独检测.肺部感染诊断时临床肺部感染评分(CPIS)、全身炎症反应综合征修正(ASS)评分均与术后5 d PCT、sTREM-1、CRP/ALB水平呈显著正相关(P＜0.05).结论 术后5d血清PCT、sTREM-1及CRP/ALB水平均可作为重型颅脑损伤术后肺部感染早期预测的有效依据,而联合检测的预测价值更高,更有利于早期对肺部感染程度及病情进展的评估.

>垂体腺瘤是神经外科鞍区最常见肿瘤,人群发生率一般为1/10万,在颅内肿瘤中仅次于胶质细胞瘤和脑膜瘤,约占颅内肿瘤的10% [1] 。近20余年来,神经内镜技术取得了突飞猛进的发展。自1992年JankowSki等 [2] 报道单纯内镜下行经鼻蝶窦入路切除垂体腺瘤后,神经内镜下经蝶窦垂体腺瘤切除术逐渐广泛应用于神经外科。张亚卓等 [3] 报

Objective To analyze the effects of early tracheotomy on the prevention and treatment of pulmonary infection for patients with severe craniocerebral injury,and provide reference for the clinical work.Methods From January 2010 to December 2011 in Baoding First Hospital,112 cases of severe craniocerebral injury were divided into two groups in accordance with the time of tracheostomy,all patients were treated with conventional therapy,for 52 cases of the control group,tracheotomy was performed ≥ 24 h after injury,for 60 cases of the observation group,tracheotomy was performed24 h after injury,the pulmonary infection and its control situation of the two groups were compared.Results The pulmonary infection incidence and mortality rate of the observation group were significantly lower than the control group with significant differences(P0.05).The cure rate of pulmonary infection and infection control time of the observation group were significantly better than the control group with significant differences(P0.05).Conclusion Early tracheotomy can significantly reduce the pulmonary infection incidence of patients with severe craniocerebral injury,and can effectively improve the lung infection condition,which is one of the first choices of the treatments in the clinical.

Objective To explore the risk factors of nosocomial pulmonary infection in brain injury patients,and to strengthen the clinical preventive measures.Methods The clinical data of 97 brain injury patients hospitalized in the First Hospital of Baoding City from June 2010 to June 2011 were analyzed retrospectively.The incidence rate of nosocomial pulmonary infection was calculated and the risk factors were analyzed.Results The incidence rate of nosocomial pulmonary infection in brain injury patients was 18.6%(18/97).The disease occurrence was not correlated with sex,weight and urinary catheter(P>0.05),but correlated with patient's age,the score of Glasgow Coma Scale,hormone application,mechanical ventilation,tracheal cut,antibiotic combinations,and gastric tube(P<0.05).Conclusions It should be noted the risk factors of nosocomial pulmonary infection of brain injury patients in clinical practice,and the clinicians should take appropriate preventive measures to reduce the incidence of nosocomial pulmonary infection and promote the rehabilitation of the patients.