摘要
目的探讨严重创伤患者血清前降钙素(PCT)与脏器损伤严重程度及预后的关系。方法 90例严重创伤患者根据并发症发生情况分为多脏器功能衰竭组(MODS组)20例,炎症反应综合征组(SIRS组)26例以及无并发症组44例,对三组患者入院时、入院第1、3、5、7、9天外周血清PCT浓度的检测及APACHRⅡ评分评估,及损伤第5天脏器损伤相关生化指标的记录。结果入院时无并发症组PCT略升高,在入院第3天水平即恢复正常;MODS组及SIRS组入院时PCT浓度均明显高于无并发症组(P均<0.05),MODS组在入院第9天PCT仍高于无并发症组(P<0.05),SIRS组入院至入院第5天PCT高于无并发症组(P<0.05),但在入院第7天PCT水平与无并发症组无异(P>0.05).(2)MODS组及SIRS组死亡率明显高于无并发症组(P均<0.05),其中MODS组升高的趋势更为明显。(3)入院第5天时MODS组及SIRS组患者血清丙氨酸氨基转移酶(ALT)、天门冬氨酸转移酶(AST)、血尿素氮(BUN)、肌酐(Cr)、血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)浓度均较无并发症组升高(P均<0.05),PO2明显低于无并发症组(P均<0.05),其中MODS组变化的幅度更为明显。(4)入院第1天时SIRS组及MODS组患者APACHEⅡ评分均明显高于无并发症组患者,其中MODS组患者升高的趋势更明显,入院第9天时无并发症组APACHEⅡ评分趋近于0,直到入院第9天,MODS组患者APACHEⅡ评分仍明显高于其余2组。(5)AST、BUN、Cr、CK、CK-MB、APACHRⅡ评分及PCT水平呈非正态分布,使用Spearman法进行相关参数相关性分析,结发现AST、BUN、Cr、CK、CK-MB、APACHRⅡ及PCT水平的表达存在相关性。结论严重创伤不同脏器损伤程度患者外周血清PCT变化不尽相同,动态监测PCT浓度变化对严重创伤患者的病情及预后有评估价值。
Objective To investigate the relation between the serum calcitonin before（PCT） in severe trauma patients and visceral injury severity and prognosis.Methods According to the situation of complications,90 patients were divided into 20 cases of multiple organ function failure group（MODS group）,26 cases of systemic inflammatory response syndrome group（SIRS）,44 patients of no complications.Peripheral blood PCT concentration detection and APACHR Ⅱ score evaluation were recorded when just be hospital and thel d,3 d,5 d,7 d,9 d of be hospitalized,and recorded the 5d of viscera damage related biochemical indicators.Results PCT increased slightly in the non-complications group when be hosipitalized,that returned to normal levels at the 3rd day;PCT concentration of MODS group and SIRS group were significantly higher than that of no complications group at the time of admission to hospital（P〈0.05）;at the 9th day,PCT of MODS group was still higher than no complications groups（P〈0.05）,SIRS group higher than without complications group（P〈0.05）during the first to fifth day,but after admission 7 d,PCT level were no significant difereces with no complications group（P 0.05）.The mortality of the MODS group and SIRS group were obviously higher than that of non-complications group（P〈0.05）,of which the MODS group had the more obvious rising trend.The 5th day,concentrations of serum alanine aminotransferase（ALT）,aspartate transaminase（AST）,blood urea nitrogen（BUN）,creatinine（Cr）,serum creatine kinase（CK）,creatine kinase isoenzyme（CK-MB） in the patients of MODS groups and SIRS group were relatively increased than the group without complication（P〈0.05）,PO2 were lower than that in group without complications（P〈0.05）,of which the change amplitude of MODS group was more apparent.The first day in hospital,APACHE Ⅱ scores of the patients in both SIRS group and MODS group were significantly higher than that of patients without complications,patients in the MODS group had the more obvious rising trend.At the 9th day,APACHE Ⅱ score approached 0 in the patients without complications,until 9th day be hospitalized,APACHE Ⅱ scores in patients of MODS group were significantly higher than the rest of the two groups.The AST,BUN,Cr,CK,CK-MB,APACHR Ⅱ score and the PCT levels were in non—normal distribution,correlation analysis of related parameters were used the Spearman method,the results showed that the AST,BUN,Cr,CK,CK-MB,APACHR Ⅱ existed the correlation with the expression of PCT level.Conclusion Peripheral blood serum PCT changes of different viscera damage degree in patients with severe trauma are not completely the same,the dynamic monitoring of PCT concentration changes have assessed value for the patient＇s condition and prognosis of the patients with severe trauma.
出处
《浙江创伤外科》
2015年第1期22-26,共5页
Zhejiang Journal of Traumatic Surgery
关键词
严重创伤
脏器损伤
PCT
预后
相关性
Severe trauma, viscera damage, PCT, prognosis, correlation
