CAJ | 학술논문

目的探讨神经外科手术后患者体温、血液白细胞计数(WBC)以及血浆C反应蛋白(CRP)变化情况在诊断术后感染中的意义. 方法选择南方医科大学南方医院神经外科自2011年7月至2012年2月收治的102例术前无感染患者作为本次研究对象,根据术后是否发生感染分为感染组(84例)与无感染组(18例),监测其术后体温、WBC及CRP水平. 结果手术后第1天,体温、WBC在无感染组及感染组患者中升高的比例差异无统计学意义(P＞0.05).术后第5天,体温、WBC在感染组患者中升高的比例分别为88.9％以及83.3％,无感染组分别为23.8％和21.4％,差异有统计学意义(P＜0.05).术后第7天结果相似.无感染组与感染组所有患者术后前3 dCRP水平均高于正常.术后第5天及第7天,无感染组中仍有92.8％和80.9％的患者的CRP水平高于正常值.ROC曲线分析结果显示,术后第5天和术后第7天上述炎症指标的诊断价值比术后前3d高.结论神经外科患者体温、CRP和WBC在术后早期非特异性升高过后呈现出下降趋势,如果指标持续不降,或者在下降后出现二次升高,则考虑发生感染的可能性大,临床上需要引起重视.
목적 탐토신경외과수술후환자체온、혈액백세포계수(WBC)이급혈장C반응단백(CRP)변화정황재진단술후감염중적의의. 방법 선택남방의과대학남방의원신경외과자2011년7월지2012년2월수치적102례술전무감염환자작위본차연구대상,근거술후시부발생감염분위감염조(84례)여무감염조(18례),감측기술후체온、WBC급CRP수평. 결과 수술후제1천,체온、WBC재무감염조급감염조환자중승고적비례차이무통계학의의(P＞0.05).술후제5천,체온、WBC재감염조환자중승고적비례분별위88.9％이급83.3％,무감염조분별위23.8％화21.4％,차이유통계학의의(P＜0.05).술후제7천결과상사.무감염조여감염조소유환자술후전3 dCRP수평균고우정상.술후제5천급제7천,무감염조중잉유92.8％화80.9％적환자적CRP수평고우정상치.ROC곡선분석결과현시,술후제5천화술후제7천상술염증지표적진단개치비술후전3d고.결론 신경외과환자체온、CRP화WBC재술후조기비특이성승고과후정현출하강추세,여과지표지속불강,혹자재하강후출현이차승고,칙고필발생감염적가능성대,림상상수요인기중시.
Objective To observe the postoperative dynamic changes of body temperature (BT),C-reactive protein (CRP) and white blood cell (WBC) count.Methods One hundred and two consecutive patients with surgically treated intracranial or spinal lesions,admitted to our hospital from July 2011 to February 2012,were chosen and divided into group A (non infection) and group B (infection) depending on whether postoperative bacterial infections (POBIs) were occurred.Evaluation of postoperative BT and CRP levels,as well as WBC count,was performed.Results WBC and BT levels would elevate in majority of patients with or without POBIs one day after the operation; the difference between the two groups showed no significant difference (P＞0.05).Elevation of BT and WBC levels was noted in 23.8％ and 21.4％ patients from group A and in 88.9％ and 83.3％ patients from group B five days after the operation,with significant difference between the two groups (P＜0.05).Similar results were seen seven day after the operation.Five and seven days after the operation,78 patients (92.8％) and 68 patients (80.9％) still had abnormal CRP level in group A.ROC curve revealed that better diagnostic performance five and seven days after the operation could be found as compared with that one and three days after the operation.Conclusion Elevation of serum CRP,WBC and BT levels can occur in patients with or without POBIs on the first three days of neurosurgical operation; persistent anomalies or secondary elevation could indicate ongoing infection,which needs attention from clinic.