[1]鄢俊安,付卫华,李前伟,等.动态监测经皮肾镜取石术术后尿脓毒症患者血清降钙素原的临床意义[J].陆军军医大学学报(原第三军医大学学报),2013,35(16):1748-1751.
 Yan Junan,Fu Weihua,Li Qianwei,et al.Clinical significance of dynamic monitoring of serum procalcitonin to predict urosepsis in patients after percutaneous nephrolithotomy[J].J Amry Med Univ (J Third Mil Med Univ),2013,35(16):1748-1751.
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动态监测经皮肾镜取石术术后尿脓毒症患者血清降钙素原的临床意义(/HTML )
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陆军军医大学学报(原第三军医大学学报)[ISSN:1000-5404/CN:51-1095/R]

卷:
35卷
期数:
2013年第16期
页码:
1748-1751
栏目:
论著
出版日期:
2013-08-30

文章信息/Info

Title:
Clinical significance of dynamic monitoring of serum procalcitonin to predict urosepsis in patients after percutaneous nephrolithotomy
作者:
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
Author(s):
Yan Jun’an Fu Weihua Li Qianwei Yao Jiwei Wang Yongquan Li Weibing
Institute of Urology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
关键词:
经皮肾镜取石术尿脓毒症降钙素原并发症
Keywords:
percutaneous nephrolithotomy urosepsis procalcitonin complication
分类号:
R347;R692.04;R699.2
文献标志码:
A
摘要:
目的      动态监测经皮肾镜取石术(percutaneous nephrolithotomy, PCNL)术后尿脓毒症患者血清降钙素原(procalcitonin,PCT)水平,探讨PCT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     回顾性分析我科2011年9月至2012年12月收治的917例上尿路结石行PCNL手术取石的患者资料,包括男性517例,女性400例,年龄(50.6±15.4)岁。动态监测围手术期患者的生命体征、血清PCT水平和WBC计数变化。PCNL术后尿脓毒症的严重程度应用序贯器官衰竭估计评分(SOFA)评估。比较术后不同严重程度感染的患者血清PCT和WBC计数的差异,评价血清PCT和WBC计数对PCNL术后尿脓毒症的诊断价值。      结果      917例患者行一期PCNL手术取石,术后31例患者出现单纯发热,107例患者发生尿脓毒症,余779例患者无感染症状,设作对照组。尿脓毒症患者中,34例诊断为严重尿脓毒症,7例出现脓毒症性休克。根据SOFA评分将不同严重程度的尿脓毒症患者分为3组,其中得分0~8分83例、9~16分16例、17~24分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评分各组间PCT水平差异均具有统计学意义(P<0.05)。对照组、单纯发热组、脓毒症组间血清WBC计数比较差异有统计学意义(P<0.05),但严重脓毒症组与脓毒症性休克组间以及SOFA评分为9~16分和17~24分的2组间血清WBC计数比较差异无统计学意义(P>0.05)。血清PCT比WBC计数对PCNL术后尿脓毒症诊断具有更高的敏感性、特异性、阳性似然比以及更低的阴性似然比。      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准确判断尿脓毒症病程进展具有重要的临床价值。
Abstract:
Objective      To evaluate the clinical significance of serum procalcitonin (PCT) levels in the early diagnosis and severity assessment of urosepsis in patients after percutaneous nephrolithotomy (PCNL) by dynamic monitoring for its levels.       Methods      Clinical data of 917 patients with upper urinary tract stones undergoing PCNL in our department from September 2011 to December 2012 were collected and retrospectively analyzed in this study. They were 517 males and 400 females, and at a mean age of 50.6±15.4. The vital signs, serum PCT levels and white blood cells (WBC) count of patients were determined during the perioperative period. The severity of urosepsis was evaluated with the sequential organ failure assessment (SOFA) score. The serum PCT and WBC count were compared in the patients with differences severity of infection after surgery, and the value of serum PCT and WBC count were assessed in the early diagnosis of postoperative PCNL urosepsis.       Results      Among the 917 cases undergoing the primary PCNL, 779 patients had no postoperative infections and served as control group. There were 31 patients with fever, and 107 patients with urosepsis. Among the 107 patients with urosepsis, there were 34 patients with severe sepsis, and 7 patients with septic shock. According to the SOFA score, the urosepsis patients were divided into 3 groups with score of 0 to 8 (n=83), 9 to 16 (n=16), and 17 to 24 (n=8) respectively. Significant differences were seen in the serum PCT level among the groups of control, simple fever, sepsis, severe sepsis and septic shock (P<0.05), and among those with different SOFA scores (P<0.05). Similarly, significant differences were found in WBC counts among the groups of control, simple fever, and sepsis (P<0.05), but not between the groups of severe sepsis and septic shock, or between the groups of SOFA 9-16 and 17-24 (P>0.05). The serum PCT level had higher sensitivity, specificity and positive likelihood ratio, and lower negative likelihood ratio in the early diagnosis of postoperative-PCNL urosepsis than WBC count.       Conclusion      The serum level of PCT is obviously correlated with the severity of infection after PCNL. Dynamic monitoring of the serum PCT level is of important clinical value for early diagnosis of urosepsis and timely judgment of postoperative-PCNL urosepsis progression.
更新日期/Last Update: 2013-08-02