普外科死亡病人血清降钙素原峰值变化趋势研究(附28例报告)  

Study on the change of dead patients' serum procalcitonin maximum in the department of general surgery: A report of 28 cases

作　　者：林超[1] 吴文川[1] 戎叶飞[1] 赵过超[1] 王单松[1] 楼文晖[1] 靳大勇[1] 秦新裕[1] 

机构地区：[1]复旦大学附属中山医院普外科,上海200032

出　　处：《中国实用外科杂志》2015年第11期1229-1231,共3页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.81272731);上海市基础研究重点项目(No.11JC1402502)

摘　　要：目的分析普外科死亡病例血清降钙素原（PCT）峰值变化趋势及其应用价值。方法回顾性分析2011年8月至2013年3月复旦大学附属中山医院普外科收治的28例死亡病人的临床资料。分析疾病构成、并发症、死亡原因、PCT等临床因素，探讨PCT与并发症、死亡原因间的关系。结果感染相关并发症5例、非感染并发症23例。死亡前两周PCTmax（病人病程中PCT最高值）〈0．5μg/L4例，0．5～2μg/L5例，〉2～10μg/6例，〉10μL/13例。在并发症和死亡原因方面，报告为非感染因素与感染性因素病人的PCTmax分布差异均无统计学意义（P〉0．05）。PCTmax〉2μg/[（5．0±1．0）d]及〉10μg/[（4．4±1．2）d]病人的存活时间分别短于PCTmax≤2μg/L/[（9,7±1．7）d]和≤10μg/L[（8．3±1．3）d]的病人（P=0．017、0．038）]，且存活时间与PCT变化趋势呈正相关关系（r=0．554，P=0．026）。结论在死亡病例并发症及死亡原因分析中低估了感染因素；动态监测PCT有助于判断感染情况及转归，协助临床诊治危重病人。Objective To analyze the changing trend and application value of serum procalcitonin peak （PCTmax）in the death cases in the department of general surgery. Methods The clinical data of 28 dead cases between August 2011 and March 2013 in Department of General Surgery, Zhongshan Hospital, Fudan University were analyzed retrospectively. The clinical data included primary disease, reported complications, reported death causes and PCT. The relationship between PCT and reported complications, death reasons were studied. Results There were 5 cases （ 17.9% ） of reported infectious complication and 23 cases （82.1%） of noninfectious complication. Evaluation of PCTmax during two weeks before death revealed the following distribution： 4 cases of PCT~〈0.5 μL/g/L, 5 cases of PCTmax0.5 -≤2 μL/g/L, 6 cases of PCTmax 〉 2 ~ 10 μL/g/L, and 13 cases of PCTmax〉10 μL/g/L. As to the complication and death cause, there was no significant difference between the cases of the reported infectious complication and those noninfectious complication （P〉0.05）. Cases of PCTmax〉2 μL/g/L[（5.0±1.0）d] had a shorter survival time than those with PCTmax≤2 μL/g/L [（9.7±1.7）d]（P=0.017）i Cases of PCTmax〉10 μg/L[（4.4± 1.2）d] had a shorter survival time than those with PCTmax≤ 10 μL/g/L[（8.3 ± 1.3）d] （P= 0.038）. The shorter survival time after PCT peak was significantly relative to the PCT changing trends （r=0.554, P= 0.026）. Conclusion The infectious factors were underestimated in the stuy. In the clinical practice, doctors should increase the frequency of PCT test in order to value the severity of infection and prognosis so as to diagnose and cure the critically ill patients better.

关 键 词：死亡病人 血清 降钙素原 并发症 

分 类 号：R6[医药卫生—外科学]