摘要
目的通过监测重症急性胰腺炎（severe acute pancreatitis,SAP）患者血清降钙素原（procalcitonin,PCT）水平的变化及术后相关并发症的发生率,探讨PCT在SAP手术时机选择及术后并发症评估中的应用。方法研究对象选自四川大学华西医院2009年9月至2011年12月期间因SAP合并不同程度胰腺坏死及感染行手术治疗的SAP患者93例。根据术前1 d血清PCT值,将93例患者分为了低水平组（PCT〈2 ng/m L）、中水平组（PCT2~10 ng/m L）和高水平组（PCT〉10 ng/m L）3组。同时记录术后患者发生的相关并发症。结果 93例患者中出现至少1种术后相关并发症的发生率为19.4%（18/93）;并发症包括术后腹腔出血13例,肠瘘14例,胰瘘18例,肺部感染4例,残余脓肿10例;行再次手术15例,死亡8例（死亡率为8.6%）。除肺部感染、A级胰瘘及C级胰瘘外,中水平组及高水平组的各项并发症发生率均高于低水平组（P〈0.05）;与入院当天比较,发病1周时发生并发症的患者PCT值明显增高（P〈0.05）;在出现术后肠瘘和残余脓肿患者中,血清PCT水平在术后1 d较术前1 d升高（P〈0.05）;与术后1 d比较,术后1周时发生残余脓肿及死亡的患者其PCT值明显增高（P〈0.05）。在死亡患者中,术后血清PCT持续处于高水平。结论术前PCT水平越高,术后发生并发症以及死亡的风险越高。通过动态监测术前血清PCT值的变化,可用于指导SAP手术时机的选择及术后肠瘘、肺部感染和死亡风险的评估,对于改善SAP患者的预后具有重要作用。
Objectives To identify the effect of procalcitonin （PCT） on the choice of operating time for severe acute pancreatitis and assessment of postoperative complications by monitoring the level of serum PCT and recording the incidence of postoperative complications. Methods Ninety-three patients who underwent debridement and drainage of infected necrosis from Sep. 2009 to Dec. 2011 were included. Serum PCT was tested on the day of admission （0 day）, one week after admission, one day before surgery, one day after surgery, and one week after surgery. According to the level of serum PCT, all the 93 patients were divided into 3 groups： low level group （PCT〈2 ng/mL）, middle level group （PCT 2-10 ng/mL）, and high level group （PCT〉10 ng/mL）. Postoperative complications were also recorded. Results The incidence of postoperative complications was 19.4% （18/93）. There were postoperative bleeding in 13 patients, intestinal fistula in 14 patients, pancreatic fistula in 18 patients, pulmonary infection in 4 patients, residual abscess in 10 patients; re-operation in 15 patients, and death in 8 patients （the death rate was 8.6%）. Besides the pulmonary infection, and grade A and C of pancreatic fistula, the incidence of various complications in middle level group and high level group were lower than low level group （P〈0.05）. Patients with complications had significantly higher PCT value in one week after admission than onset （P〈0.05）. PCT value was higher in the patients with intestinal fistula and residual abscess on one day after operation than on one day before operation （P〈0.05）. Patients who died or with re-operation had significantly higher PCT value in one week after operation than on one day after operation （P〈0.05）. In the dead patients, the serum PCT sustained at a high level after operation. Conclusions The level of serum PCT is correlated with the incidence of postoperative complications. Dynamic monitoring the level of serum PCT can guide the choice of operative t
出处
《中国普外基础与临床杂志》
CAS
2015年第1期28-32,共5页
Chinese Journal of Bases and Clinics In General Surgery
关键词
重症急性胰腺炎
降钙素原
手术时机
术后并发症
Severe acute pancreatitis
Procalcitonin
Operating time
Postoperative complication
