非感染性创伤伴PCT升高患者内毒素及血培养检测的临床意义.DOCVIP

闭合性颅脑损伤伴降钙素原升高患者内毒素及血培养检测的临床意义 裴柳 左志刚* 陈宏伟 任翔宇 王东 李亚卓 郝殿晋 邱方 （秦皇岛市第一医院 河北 秦皇岛 066000）秦皇岛市科技计划项目（ 秦皇岛市科技计划项目（201401A156） *通讯作者：左志刚 Email：zuozhigang168@163.com 摘要 目的：通过对闭合性颅脑损伤伴有降钙素原（PCT）升高患者内毒素及血培养检测指标的分析结果，探讨此类“非感染性”伴PCT升高患者PCT升高的原因。方法：选取60例闭合性颅脑损伤患者根据有无肠功能障碍分为实验组及对照组，分别采集入院后相同时期的血标本，进行PCT，内毒素，及血培养的检测。结果：实验组PCT及内毒素水平明显高于对照组，实验组血培养阳性率高于对照组且以革兰阴性菌居多，对照组血培养阳性率较低。结论：闭合性颅脑损伤患者PCT升高的原因来源于肠源性感染。 关键词 闭合性颅脑损伤； 降钙素原；内毒素；血培养；肠功能障碍 The clinical significance of detection of the endotoxin and blood culture in closed craniocerebral injury patients with elevated serum PCT levels Abstract??Objective：To explore the reason of non-infectious closed craniocerebral injury patients with elevated PCT, we detected the endotoxin and blood culture in these patients.?Method：A total of 60 patients with closed craniocerebral injury were collected and divided into the experimental group and the control group according to the absence or presence of the intestinal dysfunction. Post admission blood samples were collected at the same time with the detection of PCT, endotoxin and blood culture. Result：The levels of PCT and endotoxin and the positive rate of blood culture in the experimental group were significantly higher than those in the control group, and the majority of bacteria were Gram-negative bacteria in the experimental group. The positive rate of blood culture in control group was lower. Conclusion：The?elevated PCT levels in patients with non-infectious closed craniocerebral injury might be caused by the intestinal infection. Key words Closed craniocerebral injury； PCT ；Endotoxin；Blood culture；Bowel dysfunction 近年来，各种原因导致的创伤患者逐渐增多。且有很多研究提示创伤后常伴有全身炎症反应综合征（SIRS）、脓毒症，进而发展为多脏器功能障碍综合征（MODS）[1]，另外多发伤患者的应激状态可导致如应激性消化道出血、急性呼吸窘迫综合征等各种并发症的发生[2]。因此如何有效的阻止炎症反应的发展成为治疗成功与否的关键性因素。多研究已证实降钙素原（procalcitonin、PCT）参与炎症反应，且在严重感染的创伤患者中表达水平增高，与病情危重程度正相关[3、4]，连续监测对预后有一定的评估价值[5]。但在临床中我们发现一些创伤早期无明显感染灶的闭合性颅脑损伤患者中PCT的表达水平同样升高，原因尚不清楚。在治疗此类患者的过程中我们发现此类患者常伴有胃肠功能障碍。因此我们试图找到创伤早期伴有PCT升高与肠道的关系，从而为减少在此类患者后续治疗中发生脓毒症的治疗寻找积极的治疗