摘要
目的探讨感染性休克患者液体复苏治疗过程中血清降钙素原(PCT)、C反应蛋白(CRP)含量变化与急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分的关系。方法选择48h内液体复苏达标(CVP 8-12mm Hg,MAP≥65mm Hg)的15例感染性休克患者(休克组),采用免疫化学发光法和散射比浊法检测治疗前及治疗后24、48h血清PCT及CRP含量,行APACHEⅡ评分,分析PCT、CRP含量与APACHEⅡ评分的相关性。另选12例健康体检者作对照(对照组)。结果休克组治疗前血清PCT、CRP含量和APACHEⅡ评分高于对照组[(17.06±5.74)μg/L vs.(0.58±0.11)μg/L、(132.21±65.46)mg/L vs.(8.05±2.98)mg/L和(17.46±4.33)分vs.(6.50±1.35)分](P<0.01)。上述指标治疗后24、48h均降低(P<0.01),且治疗后48h低于治疗后24h[(8.21±4.12)μg/L vs.(9.40±3.36)μg/L、(39.68±22.26)mg/L vs.(57.21±34.56)mg/L和(8.37±4.46)分vs.(9.77±2.52)分](P<0.05)。治疗前、治疗后24h、治疗后48hAPACHEⅡ评分与PCT含量呈正相关(r=0.717、r=0.802、r=0.693,P<0.01或P<0.05),与CRP含量不相关。结论感染性休克患者血清PCT、CRP含量和APACHEⅡ评分升高,复苏过程中逐渐降低。PCT含量与APACHEⅡ评分呈较好正相关,动态监测血清PCT、CRP含量有助于评估病情和治疗。
Objective To investigate the dynamic changes of serum levels of procalcitonin （PCT） and C-reactive protein（CRP） during fluid resuscitation in patients with septic shock and their correlations with acute physiology and chronic health evaluations Ⅱ （APACHE Ⅱ ） score. Methods According to the target of resuscitation （central venous pressure 8-12 mmHg and mean arterial pressure≥65 mm Hg）, 15 patients with septic shock（group A） received enough fluid or combined with dopamine/norepinephrine for 48 h resuscitation. The serum PCT and CRP levels were measured by chemiluminescence immunoassay and immune nephelometry, respectively, and APACHE Ⅱ score was performed before resuscitation and at 24 h and 48 h after resuscitation. The relationships of serum PCT and CRP levels with APACHE Ⅱ score were analyzed. Another 12 healthy people were taken as the controls （group C）. Results The serum PCT and CRP levels and APACHE Ⅱ score before resuscitation in group A were higher than those in group C [（17.06±5.74）μg/L vs. （0. 58±0. 11）μg/L, （132. 21±65. 46） mg/L vs. （8.05±2.98） mg/L and （17.46±4. 33） points vs. （6. 50±1.35） points] （P〈0. 01）, which were markedly decreased after resuscitation （P〈0. 01 ）. All the above indexes at 48 h after resuscitation were lower than those at 24 h after resuscitation in group A[（8. 21 ±4.12） g/L vs. （9.40±3.36） g/L, （39.68±22.26） mg/L vs. （57. 21±34. 56） mg/L and （8. 37± 4.46） points vs. （9. 77±2.52） points]（P〈0.05）. APACHE Ⅱ score at all time points was positively co rrelated with serum PCT level （r = 0. 717, r = 0. 802, r = 0. 693, P〈 0.01 or P〈 0. 05 ）, but there was no correlation between APACHE 11 score and serum CRP level. Conclusion High serum PCT and CRP levels and APACHE ]I score in patients with septic shock can be decreased by optimistic resuscitation, and there is a close correlation between serum PCT level and APACHE Ⅱ score. Dynamic detection of serum PCT and CRP
出处
《江苏医药》
CAS
北大核心
2013年第20期2414-2416,共3页
Jiangsu Medical Journal
关键词
感染性休克
液体复苏
降钙素原
C反应蛋白
急性生理和慢性健康状况评分Ⅱ
Septic shock
Fluid resuscitation
Procalcitonin
C-reactive protein
Acute physiology and chronic health evaluations Ⅱ score
