降钙素原在体外循环心脏术后炎性反应中作用的研究  

The research of procalcitonin as the inflammatory response to cardiopulmonary bypass cardiac surgery

作　　者：杨旭[1] 马润伟[1] 宋怡[1] 张晓羽[1] 王霁阳[1] 臧金 甘延清[1] 王晨雷 

机构地区：[1]云南省第二人民医院心血管外科,云南昆明650021

出　　处：《云南医药》2016年第4期385-388,共4页Medicine and Pharmacy of Yunnan

摘　　要：目的通过测定体外循环心脏手术的降钙素原(procalcitonin,PCT),观察PCT变化规律并与其它炎症因子相比较,评价PCT对提示体外循环心脏术后早期并发症的临床价值。方法回顾性分析本院2015年2月-8月体外循环心脏外科术后成人患者96例,分别于术前4h(T0),术后即刻(T1),术后4h(T2),术后24h(T3),术后48h(T4),术后72h(T5),术96h(T6)7个时间点采集外周血,进行血清PCT和CRP测定,并于术后24h进行APACHEⅡ评分及序贯性脏器衰竭评价评分(sequential organ failure assessment score,SOFA)评分。根据是否出现术后并发症分为观察组和对照组,比较两组间各项指标是否存在差异,并将各项炎性指标与APACHEⅡ评分及SOFA评分行相关性分析。结果观察组和对照组在术后T2时-T4时PCT值有统计学意义(P<0.05),两组在术后T5时-T7时CRP值有统计学意义(P<0.05)。术后24h PCT与APACHE II评分及SOFA评分均呈明显正相关(P<0.05)。CRP与APACHE l I评分及SOFA评分无相关性(P>0.05)。结论体外循环心脏术后时CRP、PCT均有不同程度的升高,但和CRP相比,PCT更能早期敏感地反映术后炎症反应的轻重程度,可作为评价体外循环心脏术后预后的参考指标。Objective By measuring procalcitonin in the cardiopulmonary bypass surgery and to observe the variation of PCT compared to other inflammatory cytokines, evatuating PCT for early cardiopulmonary complications.Methods Analyzed retrospectively of the cardiopulmonary bypass cardiac surgery 96 patients from February to August in 2015, respectively preoperative 4h（T0）, immediately after operation（T1）, after 4h（T2）, after 24h（T3）, after48h（T4）, after 72h（T5）,and after 96h（T6） 7 time points of peripheral blood, and to make determination of serum PCT and CRP, score APACHEⅡ rates and Sequential Organ Failure Assessment（SOFA） at 24 hours after surgery. The patients were divided into observation group and control group depending on whether having or no postoperative complications. Results Observation group and control group had statistical significace in the postoperative PCT of T2-T4（P〈0.05）, the two groups had statistical significance in postoperative CRP of T5-T7（P〈0.05）. PCT, APACHEⅡ score and SOFA score at 24 hours after surgery were positively related（P〈0.05）. There was no correlation in CRP,with APACHE Ⅱ score and SOFA score（P〉0.05）. Conclusion CRP and PCT both have different degrees after Cardiopulmonary bypass surgery. But PCT can reflect the degree of severity of postoperative inflammation earlier and more sensitively compared with CRP, so it can be evaluated as the reference index of prognosis in cardiopulmonary bypass surgery.

关 键 词：降钙素原 体外循环心脏术后 炎性反应 

分 类 号：R654.2[医药卫生—外科学]