摘要
目的:探讨血清降钙素原(procalcitonin,PCT)和急性生理和慢性健康评分(APACHEⅡ)在指导重症监护病房(intensive care unit,ICU)恶性肿瘤患者导管相关性血性感染(cathoter related bloodstream infection,CRBSl)早期诊断及治疗中的临床价值。方法:回顾性分析82例不明原因发热怀疑CRBSI的肿瘤患者,根据《血管内导管相关感染的预防与治疗指南(2007)》将其分为CRBSI组(30例)和非CRBSI组(52例)。入组第一天留取导管尖端标本培养、中心静脉导管血培养和外周血培养,同时开始采血测定PCT(PCT检测法)及白细胞(WBC)水平,进行APACHEⅡ评分。根据PCT水平指导临床抗感染治疗,比较两组间PCT水平、WBC水平、APACHEⅡ评分在抗感染治疗前后的动态变化;比较PCT检测法与血培养法在细菌感染诊断中的灵敏性及特异性。结果:抗细菌感染治疗前CRBSI组PCT水平(3.3±0.7ng/L)显著高于非CRBSI组(1.3±0.6ng/L)P<0.001。CRBSI组(25.9±5.5)A-PACHEⅡ评分也显著高于非CRBSI组(17.2±3.9)P<0.01,WBC水平(12.3±4.3vs0.7±405)在两组间差异无显著性,P>0.05。CRBSI组抗生素治疗后,PCT水平显著下降,APACHEH评分下降,与非CRBSI相比,PCT水平(1.5±0.3vs1.2±0.4)、APACHEⅡ评分(17.1±2.8vs16.1±3.6)及WBC水平(9.39±1.54vs9.14±1.82)差异均无显著性,P>0.05。结论:PCT水平和APACHEⅡ评分对恶性肿瘤患者的CRBSI预警、及时抗感染治疗及判断预后具有很高的临床价值。
Objective： To evaluate the clinical value of procalcitonin （PCT） levels in early diagnosis and treat- ment for Catheter related bloodstream infections（CRBSI） in intensive care unit（ICU） patients with magligant tumors. Method： To retrospectively analyse 82 suspected CRBSI tumor patients withunknown reason for fever,these patients were divided into CRBSI group and non - CRBSI group according to the Intravascular Cathetet related Infection Prevention And Treatment Guidelines（2007）. Catheter tips, central catheter blood and pen- pheral blood were obtained for culture on the first day in ICU; blood samples were obtained for detecting the PCT（ PCT method） and white blood celI（WBC） levels, the scores of APACHE Ⅱ were also obtained from the first day in ICU, Anti - biotic agents were, used according to the levis of PCT, to compare the dynamic varia- tions of PCT, WBC levels, and APACHE I1 scores of the two groups before and after anti - biotic agents treat- ment. Analyses the sensitivity and specificity differences between blood culture method and PCT method in in- fection diagnosis. Results： PCT levels（3.3 ＋0.7 ng/L vs 1.3±0.6 ng/L） （P 〈0. 001 ） and APACHE Ⅱ scores（25.9 ＋ 5.5 vs 17.2±3.9 ）（ P 〈 0.01 ） were significantly higher in CRBSI group than in non CRBSI group before, anti-biotic treatment. There was no significant difference concerning WBC levels（ 12.3±4.3 vs 10.7±4.5 ） P 〉 0.05. After anti - biotic treatment, the PCT levels （ 1.5±0.3 vs 1.2±0.4）, APACHE Ⅱ scores（ 17.1±2.8 ws 16.1±3.6） ,and WBC （9.39±1.54 vs 9.14±1.82） levels Were all decreased,with no significant difference comparing non - CRBSI group, （ P 〉 0.05 ） o Conclusion ： PCT levels and APACHE Ⅱ scores may be valueable parameters in early diagnosis, timely treatment and prognosis determination.
出处
《新疆医学》
2012年第3期13-16,共4页
Xinjiang Medical Journal
关键词
导管相关性血行感染
降钙素原
恶性肿瘤
Catheter related bloodstream infection
Procalcitonin
Malignant tumor
