摘要
目的探讨血清降钙素原(PCT)在非急诊的腹部胃肠道手术围手术期累计液体平衡中的预测价值。方法分别统计95例胃肠道肿瘤术后术后3 d内与5 d内的液体进出量,并按照液体进出量的正负分为正平衡与负平衡组,监测其术后1 d、2 d、3 d、5 d的血清PCT,比较PCT及其变化率,并分析术后3 d、5 d内液体正负平衡组PCT绝对值的ROC曲线结果。结果在术后3 d内,PCT3/max/PCTmax的下降程度在正平衡组中明显低于负平衡组,差异有统计学意义(t=2.34,P<0.05)。在术后5 d内,PCT5/max/PCTmax的下降程度同样在正平衡组中明显低于负平衡组,差异有统计学意义(t=4.06,P<0.05)。ROC曲线分析显示术后第3天PCT的最佳截断值为0.74μg/L时,其曲线下面积为0.63,其灵敏度和特异度分别为:74.07%、52.91%;术后第5天PCT的最佳截断值为0.75μg/L时,其曲线下面积为0.90,灵敏度和特异度分别为:84.62%、86.59%。结论 PCT在非急诊的腹部胃肠道术后液体评估中的灵敏度和特异度均较高,可能可作为围手术期液体管理的观察指标之一。
Objective To investigate the clinical predictive value of the serum PCT in postoperative fluid balance in patients with non-emergency abdominal gastrointestinal surgery.Methods The fluid import and export volumes of 95 patients after gastrointestinal surgery within 3 days and 5 days after operation were calculated and divided into positive and negative fluid balance groups according to the fluid import and export volume.Serum PCT measurements were detected on the 1st,2nd,3rd and 5th day after the operation.ROC curve was used to analyze the PCT absolute values of two groups.Results Within 3 days after operation,the decline degree of PCT3/max/PCTmax in positive balance subgroup was significantly lower than negative balance subgroup(t=2.34,P<0.05).And within 5 days after operation,the decline degree of PCT3/max/PCTmax in positive balance subgroup was significantly lower than negative balance subgroup(t=4.06,P<0.05).The best cut-off value of PCT on 3rd day after operation was 0.74μg/L,the AUC was 0.63,and the sensitivity and specificity were 74.07%,52.91%,respectively.And the best cut-off value of PCT on 5th day after the operation was 0.75μg/L,the area under the curve(AUC)was 0.90,and the sensitivity and specificity were 84.62%,86.59%,respectively.Conclusion The sensitivity and specificity of PCT for evaluating postoperative fluid in patients with non-emergency abdominal gastrointestinal surgery are rather high,and it maybe as the observation parameter for fluid management in the perioperative period.
作者
施孝海
孙明非
张远炎
李鹏飞
刘卫怀
SHI Xiaohai;SUN Mingfei;ZHANG Yuanyan(Department of Gastrointestinal Surgery,Beilun People’s Hospital,Ningbo 315800,China)
出处
《全科医学临床与教育》
2018年第4期396-398,402,共4页
Clinical Education of General Practice
基金
浙江省宁波市科技局支持项目(2015C50033)
关键词
降钙素原
围手术期
液体平衡
procalcitonin
perioperative
fluid balance
