| Objective:To discuss and analyze the role of immune inflammatory indicators PCT(procalcitonin),SAA(serum amyloid A),hs-CRP(hypersensitive c-reactive protein)and FIB(fibrinogen))in the diagnosis and treatment of sepsis in ICU;To discuss and analyze the role of bacterial culture experiment in the diagnosis and treatment of sepsis in ICU.Methods:1.Patients in ICU departments of two hospitals in Zibo City from April 2017 to February 2019 were analyzed retrospectively according to the definition of sepsis 3.0.There were 60 patients in the sepsis group(group A),with an average age of 77.87(± 13.57)years old,including 42 males and 18 females.There were 60 patients,including 37 males and 23 females,in the non sepsis group(group B)with an average age of 76.92(±10.65).There were 45 patients in sepsis survival group(Group C),including 32 males and 13 females,with an average age of 74.73(±14.03)years old.The number of males and females among the 15 people in the sepsis death group(Group D)were 10 and 5 respectively,with the mean age 87.27(±5.57)years old.The changes of the concentrations of four inflammatory response indicators were observed.The PCTS of the two hospitals were treated by electrochemical luminescence and cyclic enhanced fluorescence immunoassay,respectively.Both SAA and hs-CRP were treated by latex immunoscattering turbidimetry and FIB were treated by coagulation.The indicators of the two hospitals were all qualified in the interstitial assessment activities of the clinical laboratory center of the national health commission every year(the total average score PT% > 98).Their results were comparable.2.The results of 235 bacteriological culture identification and drug sensitivity of 60 patients diagnosed with sepsis in two hospitals during admission were analyzed and compared.The bacterial identification instrument and the automatic bacterial drug sensitivity analyzer were carried out in both hospitals,all of which used bacterial quality control strains provided by the Shandong Provincial Inspection Center.And bacterial quality control strains were qualified in the quality assessment activities of Shandong provincial clinical inspection center every year(the total average score PT% was 100).The results were comparable.Results:1.The concentration levels of PCT,SAA and hs-CRP in the non-sepsis group were all lower than those in the sepsis group,and there was a statistical difference between the two groups(P < 0.05).The continuous detection of changes in the concentration of all indicator except for the concentration level of FIB over the treatment time was significant between the several compared groups.2.During the comparison between the area under the ROC curve and the Youden Index,ninety-five percent confidence interval was selected.It can be seen that the sensitivity and specificity of PCT were respectively 95.00% and 98.30% in the accuracy analysis of the diagnosis of sepsis.The sensitivity and specificity of SAA were 88.30% and 48.30% respectively.The specificity and sensitivity of hs-CRP were 55.00% and 90.00%,respectively.FIB had a sensitivity of 45.00% and a specificity of 71.70%,and the accuracy of PCT was the highest.The sensitivity and specificity of the combined multiple inflammatory index tests were 96.70% and 98.30%,and the accuracy of diagnosing sepsis was higher than that of a singl e inflammatory index.The relationship between PCT and SAA and hs-CRP was found to be positive(P all < 0.05),and there was no relationship between PCT and FIB(P > 0.05).3.The 235 microbial culture specimens in the two hospitals were mainly consisited of sputum specimens(63.40%),urine specimens(20.00%)and blood specimens(10.21%).The percent of G-bacteria,G+ bacteria,fungi was respectively 84.26%,11.49% and 4.26%.These bacterias were mainly composed of G-bacteria such as multi-drug-resistant acinetobacter baumannii and multi-drug-resistant pseudomonas aeruginosa.4.The drug resistance rate of G-pathogenic bacteria isolated from patients in the two hospitals for cephalosporins was generally higher.The resistance of the pathogenic bacteria was strong to a variety of commonly used antibiotics.The drug resistance rate of pseudomonas aeruginosa to cefazolin and cefotaxime was as high as 94.00% or even completely resistant.The drug resistance rates of acinetobacter baumannii to imipenem and meropenem of carbapenem,amtronine of monocytoxanum and ampicillin,gentamicin,ciprofloxacin and levofloxacin of penicillin were 69.44%?100.00%.The multidrug resistance of acinetobacter baumannii was the most serious.Conclusion:1.PCT,SAA and hs-CRP have important clinical effects in the diagnosis and treatment of sepsis patients,while the effect value of FIB is not obvious.Continuous detection of the concentration levels of the first three inflammatory indicators has a positive effect on the diagnosis and treatment of sepsis and contolling the development of the disease.2.The main pathogenic bacteria of sepsis patients are g-bacteria and they are resistant to a variety of drugs,most of them have no differences in drug resistance.Bacterial multi-drug resistance is serious,in clinic,sensitive antibiotics can be selected for the symptomatic treatment according to bacterial drug sensitivity test. |
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