动态监测血清降钙素原对术后重症继发性腹膜炎患者预后的影响  

Influence of dynamic monitoring PCT on prognosis in patients with serious secondary peritonitis after surgery

作　　者：江子欣[1] 熊旭明[1] 张振辉[1] 温艺超[1] 李智博[1] JIANG Zi-xin;XIONG Xu-min;ZHANG Zhen-hui;WEN Yi-chao;LI Zhi-bo(Intensive Care Unit,the Second Affiliated Hospital of Guangzhou Medical University,Guangdong Province,Guangzhou,510260,China)

机构地区：[1]广州医科大学附属第二医院重症医学科

出　　处：《中国当代医药》2019年第27期82-85,I0002,共5页China Modern Medicine

摘　　要：目的探讨血清降钙素原(PCT)水平及治疗后变化对重症继发性腹膜炎患者预后及生存的影响。方法回顾性分析2016年1月~2018年1月在广州医科大学附属第二医院ICU收治的118例术后重症继发性腹膜炎患者的临床资料,以28 d存活与否分为存活组(95例)与死亡组(23例);将治疗1周后的108例存活患者分为PCT值下降≥80%组(68例)与PCT值下降<80%组(40例),选取同时期的200例未发生感染患者作为正常对照组。动态观察1、3、7 d的PCT值,总结其与危重程度及生存率之间的关系。结果死亡组、存活组及正常对照组的初始PCT中位数分别为9.10、7.91、0.04 ng/L,三组比较差异有统计学意义(P<0.05)。7 d的PCT值ROC曲线下面积最大,取9.3 ng/L为截断点,敏感性为0.933,特异性为0.968。3、7 d的PCT值与ICU住院时间成正相关关系(P<0.05),PCT值与APACHEⅡ评分变化程度成正相关关系(P<0.05)。治疗1周后PCT下降≥80%组患者的月生存率显著高于PCT下降<80%组(P<0.05)。结论动态监测血清PCT对术后重症继发性腹膜炎患者预后存在一定的评估作用。Objective To investigate the influence of serum procalcitonin(PCT)levels and changes after treatment on the prognosis and survival of patients with severe secondary peritonitis.Methods The clinical data of 118 patients with severe secondary peritonitis after operation admitted to ICU of the Second Affiliated Hospital of Guangzhou Medical University from January 2016 to January 2018 were analyzed retrospectively.According to 28-day survival or not,they were divided into the survival group(95 cases)and the death group(23 cases).One week after treatment,108 surviving patients were divided into the PCT value decreased greater than or equal to 80%group(68 cases)and the PCT value decreased less than 80%group(40 cases).A total of 200 non-infected patients in the same period were selected as the normal control group.The PCT values of 1,3 and 7 days were observed dynamically,and the relationship between PCT values and severity and survival rate was summarized.Results The median of initial PCT values in the death group,the survival group and the normal control group were 9.10,7.91 and 0.04 ng/L,respectively,there was significant difference among the three groups(P<0.05).The area under the ROC curve of 7-day PCT value was the largest.The cut-off point was 9.3 ng/L,the sensitivity was 0.933,and the specificity was 0.968.There was a positive correlation between the CT value on 3 and 7 day and the length of stay in ICU(P<0.05).The change of APACHEⅡscore was positively correlated with CT value at 3 and 7 days(P<0.05).The monthly survival rate of the PCT value decreased greater than or equal to 80%group after one week of treatment was significantly higher than that of the PCT value decreased less than 80%group(P<0.05).Conclusion Dynamic monitoring of serum PCT can evaluate the prognosis of patients with severe secondary peritonitis after surgery.

关 键 词：术后 继发性腹膜炎 动态监测 降钙素原 预后 

分 类 号：R572.2[医药卫生—消化系统]