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目的探讨降钙素原(PCT)在腹部手术围手术期患者中的变化及其对预后判断的意义。方法入选住院的腹部手术围手术期患者102例,根据感染情况分为脓毒症组(n=64)和全身炎症反应综合征组(SIRS,n=38),脓毒症组根据预后(死亡组28例和存活组36例)及病情严重程度(一般脓毒症组21例、严重脓毒症组20例及脓毒症休克组23例)分组,比较各组PCT及急性生理和慢性健康状况评分Ⅱ(APACHEⅡ评分)的差异,分析PCT水平与APACHEⅡ评分的相关性,绘制64例脓毒症患者血清PCT值的受试者工作特征曲线(ROC),分析其对死亡的预测结果。结果脓毒症组患者PCT水平及APACHEⅡ评分明显高于SIRS组,脓毒症患者死亡组PCT及APACHEⅡ评分明显高于生存组,差异均有统计意义(P<0.05);一般脓毒组、严重脓毒症组、脓毒症休克组随病情程度加重,PCT水平及APACHEⅡ评分明显增加,组间比较差异有统计学意义(P<0.05)。PCT、APACHEⅡ评分之间呈正相关(r=0.75,P<0.05);对64例脓毒症患者死亡预测的血清PCT值的ROC曲线下总面积为0.974,血清PCT的最佳阈值为1.28ng/ml,其对死亡预测的敏感度为100%、特异度为97.2%。结论血清PCT值可作为腹部手术围手术期患者脓毒症监测及预后判断的指标,指导临床合理应用抗生素,降低病死率。
Objective To investigate the changes of procalcitonin (PCT) in perioperative patients undergoing abdominal surgery and its significance in prognosis. Methods Totally 102 patients undergoing perioperative abdominal surgery were divided into sepsis group (n = 64) and systemic inflammatory response syndrome group (SIRS, n = 38) according to the infection. According to the prognosis Group 28 and survival group 36) and the severity of the disease (21 in the general sepsis group, 20 in the severe sepsis group and 23 in the septic shock group) were divided into groups and compared PCT and acute physiology and chronic health (APACHEⅡscore). The correlation between PCT level and APACHEⅡscore was analyzed. The receiver operating characteristic curve (ROC) of 64 patients with sepsis was drawn, and the prediction of death was analyzed. Results The levels of PCT and APACHEⅡ in patients with sepsis were significantly higher than those in patients with SIRS. The scores of PCT and APACHEⅡ in patients with sepsis were significantly higher than those in survivors (P <0.05). In the sepsis group, Sepsis group and septic shock group increased with the severity of illness, PCT level and APACHE Ⅱ score increased significantly, the difference between the two groups was statistically significant (P <0.05). PCT and APACHEⅡscore (r = 0.75, P <0.05). The total area under the ROC curve of serum PCT value of prediction of death in 64 sepsis patients was 0.974, the optimal threshold value of serum PCT was 1.28ng / ml, its sensitivity to death prediction was 100%, specificity was 97.2%. Conclusions The serum PCT value can be used as an indicator of sepsis monitoring and prognosis in perioperative patients with abdominal surgery, guiding the rational use of antibiotics and reducing the mortality.