2017年 · 第97卷第21期

Hospital-acquired infection in critically ill neurosurgical patients is one of the key factors affecting clinical therapeutic outcome and prognosis. With the development of microscopic technology, neuronavigation technology, robotics technology, neurointerventional technology, intraoperative anesthesia technology and sub-specialties of neurosurgery critical care management, more and more operations can be carried out in neurosurgery, and the management of neurocritical patients has also become the focus of neurosurgery. Studies have shown that at present, community central nervous system infections show a downward trend, while hospital-acquired infections caused by staphylococcus and gram-negative bacteria show an upward trend. Among them, the infections involving severe neurosurgical patients are mainly central nervous system infections and pulmonary infections, while others include catheter-related infections, urinary tract infections and local wound infections. The mortality rate of central nervous system infection can be as high as 10% ~30%, and patients will have severe neurological dysfunction in the later stage^[1]While the associated pulmonary infection rate of neurosurgical critical patients was 50.7%, which seriously affected the overall survival rate and disability rate of neurosurgical critical patients.

Severe craniocerebral trauma has the characteristics of high morbidity, mortality and disability. According to statistics, in 2013, about 2.5 million people in the United States went to the emergency department for craniocerebral trauma, of which about 280,000 needed hospitalization and 56,000 died^[1]。 Currently, there are 5.3 million American people with different disabilities due to craniocerebral trauma^[2]。 Only 25% of survivors of severe craniocerebral trauma achieved long-term functional independence^[3]。 Statistical data show that the incidence of craniocerebral trauma in China has reached 100~200 people/100,000 per year, among which traffic accident injury is the first cause^[4]。 According to the preliminary statistics of China Craniocerebral Trauma Database, from 2008 to 2012, among the 11,937 patients with acute craniocerebral trauma admitted to 47 hospitals in China, the mortality rate of severe craniocerebral trauma was 27.23%, and the vegetative survival and severe disability rate was 53.17%^[5]。 The prognosis and treatment of patients with severe craniocerebral trauma have caused heavy physical, psychological and economic burden to patients themselves, their families and society. These patients have a long life expectancy after injury, and if they can't live independently, they also need to occupy huge family and social resources.

At present, due to the development of pre-hospital first aid, early diagnosis methods, intensive care system and the promotion of craniocerebral trauma treatment guidelines, the overall treatment level of craniocerebral trauma has been significantly improved, but the disability rate of severe craniocerebral trauma is still very high. In particular, patients who did not undergo rehabilitation treatment and nursing in the early stage developed complications and secondary disorders such as joint contracture, heterotopic ossification and orthostatic hypotension, which delayed the rehabilitation process and affected the rehabilitation effect. Early regular and active rehabilitation treatment can significantly improve the rehabilitation outcome and improve the quality of life of patients.

The establishment of the mechanism of coronary thrombosis has promoted the development of reperfusion therapy for ST segment elevation myocardial infarction (STEMI). In recent years, the results of research on coronary thrombosis aspiration are not consistent, and the guidelines and clinical application are also greatly affected.

Neurosurgery is one of the specialties with more critical patients, and bacterial infection is the difficulty and focus of clinical diagnosis and treatment of critical neurosurgery patients, especially hospital-acquired infection of critical neurosurgery patients is one of the important reasons that affect clinical treatment effect and prognosis of patients. According to the literature reports, the overall incidence of acquired infection in various neurosurgical central hospitals in China is about 6% ~12%^[1,2,3,4,5]The main types are hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), central nervous system infection and surgical incision infection (SSI). In addition, it also includes common infections in critically ill patients, such as urinary tract infection, catheter-associated bloodstream infection, digestive tract infection and pressure ulcer. According to the statistics led by Academician Zhao Jizong of Beijing Tiantan Hospital, the incidence of brain trauma accompanied by open skull fracture, scalp laceration or scalp laceration for more than 4 hours in neurosurgery in China is 10% ~25%; Clean-contaminated surgery includes surgery into paranasal sinus or mastoid, repair of open skull fractures or those with obvious defects in aseptic techniques, and the incidence of infection is 6.8% ~15%; The infection rate of clean surgery is 2.6% ~5%^[6]。 In the epidemiological aspect of bacteria, it is mainly coagulase-negative staphylococcus, staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterococcus, etc^[7]。

Craniocerebral trauma (TBI) is an important disease affecting human health in modern society, among which severe craniocerebral trauma (GCS ≤8 scores) is the most serious, and most survivors have various degrees of disability. The prognosis and treatment of patients with severe craniocerebral trauma have caused heavy physiological, psychological and economic burden to patients, their families and society. In previous studies, significant progress has been made in both the pathophysiological injury mechanism and the diagnosis and treatment of patients with severe craniocerebral trauma. Among them, the progress of intracranial pressure control management, various multi-parameter and multi-modal monitoring under the guidance of new technologies, the rapid development of neurocritical care medicine, and relevant standardized international and national guidelines have significantly improved the treatment effect^[1,2,3,4]。

In 1912, Herrick^[1]The relationship between coronary thrombosis and myocardial infarction was described for the first time. 1980 DeWood et al.^[2]It was confirmed that in patients with acute myocardial infarction (AMI) who underwent coronary angiography within 4 h, thrombi were present in 88% of the infarction-related vessels. 2007 Sianos et al.^[3]It was also found that coronary thrombosis was visible in 91.6% of AMI patients undergoing direct percutaneous coronary intervention (PCI). The establishment of the thrombotic mechanism of AMI has promoted the rapid development of reperfusion therapy.

At present, stroke is one of the main disabling and fatal diseases in all countries in the world. According to the "China Stroke Prevention and Treatment Report 2015", the overall standardized prevalence of stroke in China is 2.1%, and its mortality rate is still increasing at an annual rate of 8.1%. Stroke has become the first cause of death among Chinese nationals. At present, the status of stroke in China is related to the aging of our society and the changes of lifestyle. However, in recent years, air pollution is also a factor that cannot be ignored. Studies have shown that air pollution has become one of the main risk factors of stroke^[1]。 According to the national air quality situation in 2016 released by the Ministry of Environmental Protection of China, the air pollution situation in China is still severe. In 2016, among 338 cities at prefecture level and above, only 84 cities met the ambient air quality standard, and the PM 2.5 concentration in 338 cities in China was 47 μ g/m³。 The Global Burden of Disease Study shows that air pollution has become the fifth leading risk factor for stroke in East Asia in the context of overall risk factors for stroke^[2]。 Therefore, in China, the relationship between air pollution and stroke has become a scientific problem that has to be paid attention to. Below, we review the research on the relationship between air pollution and stroke, in order to provide evidence-based basis and direction for the prevention and treatment of stroke in China.

Systemic infection (sepsis) is an infection-induced dysregulated body response that leads to life-threatening organ dysfunction^[1]。 Despite the great progress in clinical diagnosis and treatment technology in recent years, systemic infection is still the main cause of death in critically ill patients caused by infection. Disorders of immune inflammatory response play a crucial role in the development of systemic infections^[2]。 Applying inappropriate immunomodulatory therapy in the absence of immune monitoring may be counterproductive, so accurate and quantitative evaluation of immune function in patients with systemic infection is crucial for rational immunomodulatory therapy.