摘要
目的研究多发伤患者创伤早期血清降钙素原(PCT)的动态变化及其与脓毒症的关系。方法纳入上海交通大学附属第六人民医院急诊创伤中心和抢救室接诊的85例多发伤患者,按是否患有全身炎性反应综合征(SIRS)和脓毒症分为SIRS组(29例)、脓毒症组(32例)和对照组(24例)。分别于创伤后6、12、24、48、72h采集患者的静脉血,采用免疫化学发光分析法检测PCT。记录患者的一般资料,包括年龄、性别、身高、体重,计算BMI(体重/身高2)。患者入选后24h内进行常规感染筛查,包括血常规、尿培养、外周血培养和胸片(或胸部CT)检查。若患者处于气管插管或气管切开中,留取支气管吸取物进行培养。同时记录患者创伤后24h内的最高体温、心率、呼吸频率、创伤严重程度评分(ISS评分)、血白细胞计数与分类、最低格拉斯哥昏迷评分(GCS评分),以及住院天数。采用多元回归分析创伤早期PCT水平与脓毒症的关系。结果脓毒症组患者的年龄显著小于SIRS组和对照组(P值均<0.01),住院天数显著长于SIRS组和对照组(P值均<0.001),入院24h内血白细胞计数、中性粒细胞比例和微生物培养阳性率均显著高于SIRS组和对照组(P值均<0.001)。3组间性别构成、BMI、ISS评分和GCS评分的差异均无统计学意义(P值均>0.05)。3组患者的血清PCT水平在创伤后24h均达到峰值,与同组其他时间点比较差异均有统计学意义(P值均<0.05);脓毒症组创伤后各时间点的血清PCT水平均显著高于对照组同时间点(P值均<0.05),创伤后12、24、48、72h的血清PCT水平均显著高于SIRS组同时间点(P值均<0.05);SIRS组与对照组间创伤后各时间点的血清PCT水平的差异均无统计学意义(P值均>0.05)。多因素Logistic回归分析发现,在校正年龄、性别、BMI、ISS评分、GCS评分、住院天数、血白细胞计数、血中性粒细胞比例后,创伤后12、24和72h的血清PCT水平均是脓毒症�
Objective To study the dynamic changes of procalcitonin in patients with multiple traumas at the early stage, and to explore its relation with sepsis. Methods A total of 85 patients with multiple traumas admitted to the Emergency Trauma Center and the Emergency Room of Shanghai Sixth People＇ s Hospital were enrolled in this study. Of them, 29 suffered from systemic inflammatory response syndrome （SIRS） and sepsis （SIRS group）, 32 with sepsis （sepsis group）, and 24 without SIRS or sepsis （control group）. Blood samples were collected at 6, 12, 24, 48 and 72 hours after trauma. Serum procalcitonin was measured by immunochemiluminometry. The general information of patients including age, gender, height, weight, and body mass index （BMI） were recorded. Routine infection screening was performed within 24 hours after inclusion, including routine blood test, urine culture, peripheral blood culture and chest X-ray （or chest CT）. Bronchialaspirates were taken for culture if the patients were under endotracheal intubation or tracheotomy. The highest temperature, heart rate, respiratory rate, injury severity score （ISS）, white blood cell （WBC） count, neutrophil percentage, and lowest Glasgow coma score （GCS） within 24 hours after trauma, as well as hospJtaJ stay were also recorded. Multiple Logistic regression analysis was applied to analyze the relationship between procalcitonin concentration and sepsis at the early period of trauma. Results The patients in the sepsis group were younger （P〈 0.01 ）, stayed longer in hospital （ P 〈 0. 001 ）, and had higher WBC count, neutrophil percentage and positive rate of microbial culture （all P〈0. 001） than those in the SIRS group and control group wihtin 24 hours after trauma. There were no significant difference in sex composition, BMI, ISS or GCS between groups （all P〈 0.05）. The serum procalcitonin concentration of the 3 groups reached the peak at 24 hours after trauma, which was significantly higher than that at the othe
出处
《上海医学》
北大核心
2017年第10期618-623,共6页
Shanghai Medical Journal
基金
国家临床重点专科建设项目基金资助(2013-2014年度)
关键词
多发伤
降钙素原
脓毒症
Multiple traumas
Procalcitonin
Sepsis
