1 research outputs found
Π§Π°ΡΡΠΎΡΠ° ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΡ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΠΈ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠ³ΠΎ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΎΡΠ²Π΅ΡΠ° Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠΌ Π½Π°ΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΠΎΠ·Π½Π°Π½ΠΈΡ
Objective: investigate epidemiology of infectious complications, intensity of antibacterial therapy, and features of the systemic inflammatory response in patients with prolonged disorders of consciousness.Materials and methods: retrospective case histories analysis of 102 patients with prolonged disorders of consciousness who were treated in the department of anesthesiology and intensive care of Polenov Neurosurgical Institute from 2010 to 2019.Results: during hospitalization all patients (100%) had signs of tracheobronchitis, 86 patients (84,3%) had urinary tract infection, 34 (33,3%) pneumonia, 10 patients (9,8%) meningoventriculitis, and in 9 (8,8%) cases sepsis was diagnosed. Identified bacterial complications required systemic antibacterial therapy. With an average length of hospital stay of 51Β±42 days, duration of antibiotic therapy was 37Β±41 days. One-component therapy was applied in half of the cases (54%), slightly less often (43,2%) treatment consisted of two antibiotics, in some cases patientβs condition required prescription of three antibiotics (2,8%). Even in the absence of a focus of infection, temperature and laboratory markers of inflammation in blood samples of patients with prolonged disorders of consciousness were higher than the reference values. CRP was increased with addition of any bacterial complications. Count of white blood cells significantly increased only in case of pneumonia and sepsis. Procalcitonin test was positive in 16,6% observations of urinary tract infection, 30,4% of pneumonia, and 28% of meningoventriculitis.Conclusion: most informative proinflammatory marker of bacterial complications in patients with prolonged disorders of consciousness was CRP. Mild leukocyte response can be explained by immunosuppression in long-term ill patients. Limited value of procalcitonin test may be due to the insufficiency of the semi-quantitative method sensitivity with a threshold level of 0,5 ng/ml, as well as reduced proinflammatory response to local infection in patients with prolonged disorders of consciousness as a result of massive antibacterial therapy, colonization of opportunistic microflora and presence of sympathicotonia (non-infectious systemic inflammatory reaction).Β Π¦Π΅Π»Ρ: ΠΈΠ·ΡΡΠΈΡΡ ΡΠΏΠΈΠ΄Π΅ΠΌΠΈΠΎΠ»ΠΎΠ³ΠΈΡ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ, ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΡΡΡ Π°Π½ΡΠΈΠ±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΈ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠ³ΠΎ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΎΡΠ²Π΅ΡΠ° Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠΌ Π½Π°ΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΠΎΠ·Π½Π°Π½ΠΈΡ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ: ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ ΡΠ΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· ΠΈΡΡΠΎΡΠΈΠΉ Π±ΠΎΠ»Π΅Π·Π½ΠΈ 102 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠΌ Π½Π°ΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΠΎΠ·Π½Π°Π½ΠΈΡ, ΠΏΡΠΎΡ
ΠΎΠ΄ΠΈΠ²ΡΠΈΡ
Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π² ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠΈ Π°Π½Π΅ΡΡΠ΅Π·ΠΈΠΎΠ»ΠΎΠ³ΠΈΠΈ-ΡΠ΅Π°Π½ΠΈΠΌΠ°ΡΠΈΠΈ Π ΠΎΡΡΠΈΠΉΡΠΊΠΎΠ³ΠΎ Π½Π°ΡΡΠ½ΠΎΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»ΡΡΠΊΠΎΠ³ΠΎ Π½Π΅ΠΉΡΠΎΡ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈΠ½ΡΡΠΈΡΡΡΠ° ΠΈΠΌ. ΠΏΡΠΎΡΠ΅ΡΡΠΎΡΠ° Π.Π. ΠΠΎΠ»Π΅Π½ΠΎΠ²Π° Ρ 2010 ΠΏΠΎ 2019 Π³.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ: Ρ Π²ΡΠ΅Ρ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (100%) Π·Π° Π²ΡΠ΅ΠΌΡ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ ΠΏΡΠΈΡΡΡΡΡΠ²ΠΎΠ²Π°Π»ΠΈ ΠΏΡΠΈΠ·Π½Π°ΠΊΠΈ ΡΡΠ°Ρ
Π΅ΠΎΠ±ΡΠΎΠ½Ρ
ΠΈΡΠ°, Ρ 86 Π±ΠΎΠ»ΡΠ½ΡΡ
(84,3%) Π±ΡΠ»Π° ΠΎΠ±Π½Π°ΡΡΠΆΠ΅Π½Π° ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ ΠΌΠΎΡΠ΅Π²ΡΠ²ΠΎΠ΄ΡΡΠΈΡ
ΠΏΡΡΠ΅ΠΉ, Ρ 34 (33,3%) β ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΡ, Ρ 10 (9,8%) β ΠΌΠ΅Π½ΠΈΠ½Π³ΠΎΠ²Π΅Π½ΡΡΠΈΠΊΡΠ»ΠΈΡ, Ρ 9 (8,8%) β ΡΠ΅ΠΏΡΠΈΡ. ΠΡΡΠ²Π»Π΅Π½Π½ΡΠ΅ Π±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΡΠ΅ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ ΠΏΠΎΡΡΠ΅Π±ΠΎΠ²Π°Π»ΠΈ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ Π°Π½ΡΠΈΠ±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ. ΠΡΠΈ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ ΠΏΡΠ΅Π±ΡΠ²Π°Π½ΠΈΡ Π±ΠΎΠ»ΡΠ½ΠΎΠ³ΠΎ Π² ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ΅ Π² ΡΡΠ΅Π΄Π½Π΅ΠΌ 51Β±42 Π΄Π½Ρ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ Π°Π½ΡΠΈΠ±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° Π² ΡΡΠ΅Π΄Π½Π΅ΠΌ 37Β±41 Π΄Π΅Π½Ρ. ΠΠ΄Π½ΠΎΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠ½Π°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»Π°ΡΡ Π² ΠΏΠΎΠ»ΠΎΠ²ΠΈΠ½Π΅ ΡΠ»ΡΡΠ°Π΅Π² (54%), ΡΡΡΡ ΡΠ΅ΠΆΠ΅ (43,2%) Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΡΠΎΡΡΠΎΡΠ»ΠΎ ΠΈΠ· Π΄Π²ΡΡ
Π°Π½ΡΠΈΠ±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΡΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ², Π² ΠΎΡΠ΄Π΅Π»ΡΠ½ΡΡ
ΡΠ»ΡΡΠ°ΡΡ
ΡΠΎΡΡΠΎΡΠ½ΠΈΠ΅ Π±ΠΎΠ»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ΅Π±ΠΎΠ²Π°Π»ΠΎ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΡΡΠ΅Ρ
Π°Π½ΡΠΈΠ±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΡΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² (2,8%). ΠΠ°ΠΆΠ΅ Π² ΠΎΡΡΡΡΡΡΠ²ΠΈΠ΅ ΠΎΡΠ°Π³Π° ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΡΡΡΠ° ΠΈ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΠ΅ ΠΌΠ°ΡΠΊΠ΅ΡΡ Π²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΡ Π² ΠΊΡΠΎΠ²ΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠΌ Π½Π°ΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΠΎΠ·Π½Π°Π½ΠΈΡ Π±ΡΠ»ΠΈ Π²ΡΡΠ΅ ΡΠ΅ΡΠ΅ΡΠ΅Π½ΡΠ½ΡΡ
ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ. Π‘Π Π ΡΠ²Π΅Π»ΠΈΡΠΈΠ²Π°Π»ΡΡ ΠΏΡΠΈ ΠΏΡΠΈΡΠΎΠ΅Π΄ΠΈΠ½Π΅Π½ΠΈΠΈ Π²ΡΠ΅Ρ
Π±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ. ΠΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ Π»Π΅ΠΉΠΊΠΎΡΠΈΡΠΎΠ² Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎ ΠΏΠΎΠ²ΡΡΠ°Π»ΠΎΡΡ ΡΠΎΠ»ΡΠΊΠΎ Ρ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ΠΌ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ ΠΈ ΡΠ΅ΠΏΡΠΈΡΠ°. ΠΡΠΎΠΊΠ°Π»ΡΡΠΈΡΠΎΠ½ΠΈΠ½ΠΎΠ²ΡΠΉ ΡΠ΅ΡΡ Π±ΡΠ» ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΡΠΌ Π² 16,6% ΡΠ»ΡΡΠ°Π΅Π² ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΉ ΠΌΠΎΡΠ΅Π²ΡΠ²ΠΎΠ΄ΡΡΠΈΡ
ΠΏΡΡΠ΅ΠΉ, 30,4% ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΉ ΠΈ 28% ΠΌΠ΅Π½ΠΈΠ½Π³ΠΎΠ²Π΅Π½ΡΡΠΈΠΊΡΠ»ΠΈΡΠΎΠ².ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅: Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠ²Π½ΡΠΌ ΠΏΡΠΎΠ²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠΌ ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠΌ Π² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ Π±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠΌ Π½Π°ΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΠΎΠ·Π½Π°Π½ΠΈΡ ΠΎΠΊΠ°Π·Π°Π»ΡΡ Π‘-ΡΠ΅Π°ΠΊΡΠΈΠ²Π½ΡΠΉ Π±Π΅Π»ΠΎΠΊ. Π‘Π»Π°Π±ΠΎ Π²ΡΡΠ°ΠΆΠ΅Π½Π½Π°Ρ Π»Π΅ΠΉΠΊΠΎΡΠΈΡΠ°ΡΠ½Π°Ρ ΡΠ΅Π°ΠΊΡΠΈΡ ΠΌΠΎΠΆΠ΅Ρ ΠΎΠ±ΡΡΡΠ½ΡΡΡΡΡ ΠΈΠΌΠΌΡΠ½ΠΎΡΡΠΏΡΠ΅ΡΡΠΈΠ΅ΠΉ Ρ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎ Π±ΠΎΠ»Π΅ΡΡΠΈΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². ΠΠ³ΡΠ°Π½ΠΈΡΠ΅Π½Π½Π°Ρ ΡΠ΅Π½Π½ΠΎΡΡΡ ΠΏΡΠΎΠΊΠ°Π»ΡΡΠΈΡΠΎΠ½ΠΈΠ½Π° ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»Π΅Π½Π° Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΠΉ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡΡ ΠΏΠΎΠ»ΡΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΌΠ΅ΡΠΎΠ΄Π° Ρ ΠΏΠΎΡΠΎΠ³ΠΎΠ²ΡΠΌ ΡΡΠΎΠ²Π½Π΅ΠΌ 0,5 Π½Π³/ΠΌΠ», Π° ΡΠ°ΠΊΠΆΠ΅ ΡΠ½ΠΈΠΆΠ΅Π½Π½ΡΠΌ ΠΏΡΠΎΠ²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠΌ ΠΎΡΠ²Π΅ΡΠΎΠΌ Π½Π° Π»ΠΎΠΊΠ°Π»ΡΠ½ΡΡ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠΌ Π½Π°ΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΠΎΠ·Π½Π°Π½ΠΈΡ Π² ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ΅ ΠΌΠ°ΡΡΠΈΠ²Π½ΠΎΠΉ Π°Π½ΡΠΈΠ±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, ΠΊΠΎΠ»ΠΎΠ½ΠΈΠ·Π°ΡΠΈΠΈ ΡΡΠ»ΠΎΠ²Π½ΠΎ-ΠΏΠ°ΡΠΎΠ³Π΅Π½Π½ΠΎΠΉ ΡΠ»ΠΎΡΡ, Π½Π°Π»ΠΈΡΠΈΡ ΡΠΈΠΌΠΏΠ°ΡΠΈΠΊΠΎΡΠΎΠ½ΠΈΠΈ (Π½Π΅ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΠΎΠΉ ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠΉ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΡΠ΅Π°ΠΊΡΠΈΠΈ).