摘要
目的分析经皮肾镜取石术(PCNL)术前及术后监测降钙素原对感染的早期诊断及尿源性脓毒血症预防的临床意义。方法选取本院于2016年1月至2018年10月间收治的122例肾结石或输尿管上段结石并行PCNL手术治疗的患者,根据其术后是否发生感染将其分为感染组及非感染组,将感染组根据不同感染程度及不同SOFA评分进行分组,比较不同组间的炎症指标。根据ROC曲线分析PCT及CRP的诊断价值。结果术后感染组PCT、CRP、WBC水平均明显高于术前及非感染组术后水平(P<0.05)。不同感染程度患者治疗前的PCT水平比较差异有统计学意义(P<0.05),治疗后血清PCT均较治疗前明显下降,不同感染程度患者治疗后及脓毒症组治疗后的血清CRP均明显低于治疗前,但严重脓毒症及脓毒症休克组患者治疗前后比较差异无统计学意义(P>0.05),根据SOFA评分,术后各组间PCT水平比较差异均有统计学意义(P<0.05),CRP在评分>9分的患者间比较差异无统计学意义(P>0.05)。ROC曲线显示PCT的曲线下面积大于CRP(P<0.05)。结论患者血清PCT水平与PCNL术后感染程度有良好的相关性,动态监测PCT变化对术后早期诊断尿脓毒血症及准确判断其进展有着重要的临床价值。
Objective To analyze the clinical significance of monitoring of procalcitonin for early diagnosis of infection and prevention of urinary sepsis before and after percutaneous nephrolithotomy(PCNL).Methods A total of 122 patients with renal calculi treated with PCNL surgery between January 2016 and October 2018 were enrolled.The patients were divided into infected group and non-infected group according to whether they were infected or not.According to different infection levels and different SOFA scores,the indicators of inflammation between different groups were compared.The diagnostic value of PCT and CRP was analyzed according to the ROC curve.Results The levels of PCT,CRP and WBC in the postoperative infection group were significantly higher than those in the preoperative and non-infected groups(P<0.05).The PCT levels before treatment were significantly different in patients with different degrees of infection(P<0.05).After treatment,serum PCT was significantly lower than before treatment.CRP levels of patients with different degrees after treatment and the sepsis group were lower than before treatment,and serum CRP levels in patients with severe sepsis and septic shock were not significantly different compare with before treatment(P>0.05).According to SOFA score,postoperative PCT levels had significant differences(P<0.05).There was no significant difference in CRP between patients with scores greater than 9 points(P>0.05).The results of ROC curve analysis showed that the area under the curve of serum PCT was greater than CRP(P<0.05).Conclusions There is a good correlation between serum PCT level and PCNL infection.Dynamic monitoring of PCT changes has important clinical value for early diagnosis of urinary sepsis and accurate judgment of its progress.
作者
秦国东
于文春
邱明
龙平华
Qin Guodong;Yu Wenchun;Qiu Ming;Long Pinghua(Department of Urology,the People's Hospital of Dazu District,Chongqing 402360,China;Department of Anesthesiology,the People's Hospital of Dazu District,Chongqing 402360,China)
出处
《国际泌尿系统杂志》
2020年第3期419-422,共4页
International Journal of Urology and Nephrology
基金
重庆市卫生和计划生育委员会基金资助项目(2013-2-253)。
关键词
肾造口术
经皮
降钙素
脓毒症
感染
Nephrostomy
Percutaneous
Calcitonin
Sepsis
Infection
