动态监测PCNL术后尿脓毒症患者血清降钙素原的临床意义鄢俊安付.DOC

动态监测PCNL术后尿脓毒症患者血清降钙素原的临床意义 鄢俊安 付卫华 李前伟 姚基伟 王永权 李为兵* (第三军医大学西南医院全军泌尿外科研究所, 重庆400038) 摘要: 目的　探讨动态监测PCNL术后尿脓毒症患者血清降钙素原( PCT)水平对尿脓毒症早期诊断及判断尿脓毒症严重程度的临床意义。方法 对917例PCNL手术患者围手术期血清PCT水平和血常规检查，并持续监测发生感染及尿脓毒症患者PCT和WBC的变化，应用序贯器官衰竭估计评分(SOFA)评估尿脓毒症的严重程度。结果 917例患者行一期PCNL手术取石，术中或术后出现单纯发热患者31例(3.4%)，尿脓毒症的患者107例(11.7%)，其中34例(3.7%)尿脓毒症患者伴有的脏器功能障碍，7例(0.8%)出现脓毒症性休克。根据SOFA评分又将尿脓毒症患者分为0~8、9~16、17~24三组，各组分别为83、16、8例。对照组、单纯发热组、脓毒症组、严重脓毒症组、脓毒症性休克组以及SOFA分组各组间PCT水平差异均具有统计学意义(P< 0. 05)。WBC计数在对照组、单纯发热组、脓毒症组之间比较出现统计学上显著差异( P < 0. 05)，但在严重脓毒症与脓毒症性休克组间以及SOFA>9的两组间无明显差异( P > 0. 05)。此外，血清PCT水平比WBC计数对PCNL术后尿脓毒症诊断具有更高的敏感性和特异性。结论　患者血清PCT水平与PCNL术后感染严重程度有良好的相关性，动态监测血清PCT水平变化对PCNL术后早期诊断尿脓毒症的发生以及及时准确的判断尿脓毒症病程进展具有重要的临床价值。 关键词: 经皮肾镜取石术; 尿脓毒症; 降钙素原; 并发症 Clinical significance of dynamic monitoring of serum procalcitonin level procalcitonin in patients with postoperative-PCNL urosepsis Yan Junan Fu Weihua Li Qianwei Yao Jiwei Wang Yongquan Li Weibing* (Center for Urology of PLA，Southwest Hospital，Third Military Medical University，Chongqing 400038，China) Abstract: OBJECTIVE To evaluate the clinical significance of the early diagnosis and severity assessment of postoperative-PCNL urosepsis by dynamic monitoring for serum procalcitonin(PCT) levels in patients. METHODS A total of 917 cases underwent PCNL operations were involved in the study. The serum PCT and complete blood count of patients was determined during the HYPERLINK "/perioperative_period" perioperative period. If the symptoms of infection found, the serum PCT and white blood cells counts (WBC) of patients were continuously monitored. The severity of urosepsis were evaluated with sepsis related organ failure assessment (SOFA). RESULTS Among 917 cases undergone the primary PCNL, There were 31 (3.4%) patients with fever, 107 (11.7%) patients with urosepsis, and there were 34 septic patients with multiple organ dysfunction syndrome (MODS), 7 patients with septic shock. According to SOFA score, the septic patients were divided into 0-8, 9-16, 17-24