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目的探讨C-反应蛋白及降钙素原在创伤后脓毒血症中的动态变化及对预后的评估价值。方法选择诸暨市中心医院创伤后脓毒血症患者78例作为研究对象,比较脓毒血症组与对照组之间血清CRP及PCT水平的差异。根据脓毒血症的不同程度将入选的创伤后脓毒血症病例分为单纯脓毒血症、脓毒血症合并器官功能衰竭及感染性休克组,比较三组患者血清CRP水平、血清PCT水平及APACHE-Ⅱ评分的差异。根据不同的随访结果将脓毒血症患者分为好转、无效及病死组,比较三组入选当日、入选后第3、5天血清CRP及PCT水平的变化。结果入选当日,脓毒血症组患者血清CRP及PCT水平均明显高于对照组,差异具有统计学意义(t=68.472、40.243,P<0.01)。不同程度脓毒血症组患者血清CRP、PCT水平及APACHE-Ⅱ评分均不完全相同(F=3.804、8.292、5.273,P<0.05),单纯脓毒血症及脓毒血症合并器官功能衰竭组在血清CRP水平上差异无统计学意义(P>0.05),其余两组间比较差异均有统计学意义(P<0.05);脓毒血症患者中,好转组入选后第5天血清CRP水平较入选当日及第3天降低(P<0.05),但入选当日及第3天CRP水平差异无统计学意义(P>0.05);血清PCT水平入选当日、入选后第3天、第5天呈逐渐下降趋势,组间比较差异均有统计学意义(P<0.05)。病死组患者血清CRP水平入选当日、入选后第3天、第5天均差异无统计学意义(P>0.05),而血清PCT水平呈递增趋势,组间比较差异均有统计学意义(P<0.05)。无效组血清CRP及PCT水平入选当日、入选后第3天、第5天差异均无统计学意义(P>0.05)。结论血清CRP及PCT水平均能反应创伤后脓毒血症的感染状态,但在评估病情及预后方面,血清PCT更具有优势。
Objective To investigate the dynamic changes of C-reactive protein and procalcitonin in post-traumatic sepsis and its prognostic value. Methods 78 patients with post-traumatic sepsis in Zhuji Central Hospital were selected as the research object to compare the difference of serum CRP and PCT between sepsis group and control group. According to the different degrees of sepsis, the selected cases of post-traumatic sepsis were divided into simple sepsis, sepsis with organ failure and septic shock group. The levels of serum CRP, serum PCT Level and APACHE-Ⅱ score differences. According to different follow-up results, patients with sepsis were divided into two groups: improvement, ineffectiveness and death. The changes of serum CRP and PCT levels on the 3rd, 5th day after the selection were compared between the three groups. Results On the day of selection, serum CRP and PCT levels in patients with sepsis were significantly higher than those in the control group (t = 68.472, 40.243, P <0.01). The levels of serum CRP, PCT and APACHE-Ⅱ in patients with different sepsis groups were not identical (F = 3.804, 8.292, 5.273, P <0.05), sepsis and sepsis with organ failure There was no significant difference in the level of serum CRP between the two groups (P> 0.05), and the difference between the other two groups was statistically significant (P <0.05). In sepsis patients, the serum CRP (P <0.05), but there was no significant difference in the CRP levels between the day of selection and the third day (P> 0.05). The serum PCT levels were on the day of selection, the third day, the fifth day Showed a gradual downward trend, the difference between the groups were statistically significant (P <0.05). Serum CRP levels in the patients died on the day of selection were not statistically significant (P> 0.05) on the 3rd day and the 5th day after admission, while the serum PCT levels showed an increasing trend with significant difference between the two groups (P < 0.05). In the ineffective group, the serum CRP and PCT levels were selected on the same day, there was no significant difference (P> 0.05) on the 3rd and 5th day after the selection. Conclusions Both serum CRP and PCT levels can reflect the infection status of post-traumatic sepsis. However, serum PCT is more advantageous in evaluating the condition and prognosis.