动态监测降钙素原判断重症肺炎治疗预后的临床观察
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摘要
目的:探讨动态监测降钙素原(PCT)判断重症肺炎治疗的预后临床观察。方法:选取2017年4月-2018年12月期间在本院ICU病房收治的68例重症肺炎患者作为观察对象,依据治疗后的预后情况,将其分为存活组46例和死亡组22例,比较两组患者在ICU第1、3、5、7天的血清PCT水平、中性粒细胞百分比(NEU)、超敏C反应蛋白(hs-CRP)以及急性生理与慢性健康状况评分(APACHEⅡ评分)情况。结果:ICU第1天,在PCT、NEU、hs-CRP指标方面,存活组略低于死亡组,但差异无统计学意义(P>0.05)。存活组、死亡组的APACHEⅡ评分分别为(51.32±5.73)、(56.74±6.68)分,存活组低于死亡组(P<0.05)。ICU第3、5、7天,两组患者在NEU、hs-CRP指标方面,差异均无统计学意义(P>0.05)。存活组的PCT以及APACHEⅡ评分均低于死亡组,差异均有统计学意义(P<0.05)。存活组的PCT水平呈现逐渐下降的趋势,死亡组的PCT水平呈现上升趋势,存活组与死亡组APACHEⅡ评分的变化趋势与PCT水平的变化趋势一致,PCT与APACHEⅡ评分之前的关系为正相关(r=0.416,P=0.000)。结论:在对重症肺炎患者进行治疗的过程中,应动态监测血清PCT水平的变化情况,为预后判断提供参考。
Objective:To investigate the prognostic observation of dynamic monitoring procalcitonin(PCT in the treatment of severe pneumonia.Method:From April 2017 to December 2018,68 patients with severe pneumonia were selected from our ICU ward as observation objects.According to the prognosis after treatment,they were divided into survival group of 46 cases and dead group of 22 cases.The serum PCT level,neutrophil percentage(NEU),hypersensitive C-reactive protein(hs-CRP),acute physiological and chronic health status score(APACHE Ⅱ)of two groups at the first,third,fifth,seventh day in ICU were compared.Result:In the first day of ICU,the levels of PCT,NEU,hs-CRP in survival group were slightly lower than those of dead group,but there were no statistical differences(P>0.05).The APACHE Ⅱ scores of survival group was(51.32±5.73)score lower than that of dead group(56.74±6.68)score(P<0.05).The third,fifth and seventh day in ICU,there were no significant differences in NEU and hs-CRP of two groups(P>0.05),the scores of PCT and APACHEⅡ in survival group were significantly lower than those in dead group(P<0.05).The level of PCT decreased gradually in survival group,and the level of PCT increased in dead group.The change trend of APACHE Ⅱ score was the same as that of PCT level in survival group and dead group,the relationship between PCT and APACHEⅡ score was positive correlation(r=0.416,P=0.000).Conclusion:The serum should be monitored dynamically during the treatment of severe pneumonia patients.The change of PCT level provides a reference for prognostic judgement.
Objective:To investigate the prognostic observation of dynamic monitoring procalcitonin(PCT in the treatment of severe pneumonia.Method:From April 2017 to December 2018,68 patients with severe pneumonia were selected from our ICU ward as observation objects.According to the prognosis after treatment,they were divided into survival group of 46 cases and dead group of 22 cases.The serum PCT level,neutrophil percentage(NEU),hypersensitive C-reactive protein(hs-CRP),acute physiological and chronic health status score(APACHE Ⅱ)of two groups at the first,third,fifth,seventh day in ICU were compared.Result:In the first day of ICU,the levels of PCT,NEU,hs-CRP in survival group were slightly lower than those of dead group,but there were no statistical differences(P>0.05).The APACHE Ⅱ scores of survival group was(51.32±5.73)score lower than that of dead group(56.74±6.68)score(P<0.05).The third,fifth and seventh day in ICU,there were no significant differences in NEU and hs-CRP of two groups(P>0.05),the scores of PCT and APACHEⅡ in survival group were significantly lower than those in dead group(P<0.05).The level of PCT decreased gradually in survival group,and the level of PCT increased in dead group.The change trend of APACHE Ⅱ score was the same as that of PCT level in survival group and dead group,the relationship between PCT and APACHEⅡ score was positive correlation(r=0.416,P=0.000).Conclusion:The serum should be monitored dynamically during the treatment of severe pneumonia patients.The change of PCT level provides a reference for prognostic judgement.
引文
[1]胡亮,丁绍华,胡小华.血清降钙素原检测对婴幼儿重症肺炎的预后评估价值探讨[J].基层医学论坛,2017,11(14):453-454.
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[5]刘天富,杨薇.降钙素原、C-反应蛋白、白细胞水平与重症肺炎患者预后的相关性分析[J].世界临床医学,2016,10(17):458-459.
[6]徐玉辉,魏健平.血降钙素原、内毒素及中性粒细胞表面抗原CD64在重症肺炎鉴别诊断中的临床意义[J].现代医院,2017,14(1):124-127.
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[8]杨锦旺,田荣华,薛明月.降钙素原与D-二聚体动态变化在重症肺炎患者预后预测中的价值[J].现代仪器与医疗,2018,24(2):73-75.
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[11]李晓华,吕巧云,温子海.老年糖尿病伴重症肺炎患者血清炎性反应及降钙素原变化的意义[J].河北医科大学学报,2016,37(3):316-318.
[12]林桂仪,汪洁.相关指标变化对重症肺炎抗菌药物应用的指导意义[J].实用药物与临床,2016,19(7):857-860.
[13]周静,石振东.痰热清注射液治疗老年重症肺炎的临床疗效及对血清超敏C反应蛋白、降钙素原的影响[J].检验医学与临床,2017,14(11):121-123.
[14]刘红,刘培政.血清降钙素原在婴幼儿重症肺炎早期诊断中的价值[J].实用临床医药杂志,2016,20(7):105-108.
[15]岳煜,李欣,卢巧喜.清肺逐瘀汤佐治重症肺炎的疗效及对血清降钙素原的影响[J].中国临床研究,2016(9):1269-1270.
[16]郭玮,何煜婷,邵琦.联合血降钙素原、脑钠肽、D-二聚体及PCIS评分对评估儿童重症肺炎预后的价值[J].临床儿科杂志,2017,35(8):575-579.
[17]张芳芳,尹占良,邱建凯.重症肺炎患儿降钙素原与凝血纤溶指标的临床意义[J].热带医学杂志,2016,16(11):1423-1425.
[18]甘斌,黄业清,罗红伟.重症肺炎患者PCTWBCCRP水平与预后的相关性分析[J].河北医学,2016,22(12):2018-2021.
[19]陈映红,熊涛.不同炎性指标评估重症肺炎患者病情变化的临床对比研究[J].检验医学与临床,2017,14(7):926-928.
[20]李琼,张晚生,史加强,等.动态监测重症肺炎患者血清降钙素原的临床意义[J].中国实用医刊,2016,43(10):115-116.
[2]张桐.降钙素原检测对老年人重症肺炎病情严重性及预后的判断价值[J].中国基层医药,2016,23(21):231-232.
[3]林大勇.降钙素原检测在重症肺炎治疗中的应用价值[J].中国当代医药,2016,23(6):37-39.
[4]张莉娜,万俊.婴幼儿重症肺炎血PCT及乳酸监测的临床意义[J].中国医学创新,2016,13(31):21-24.
[5]刘天富,杨薇.降钙素原、C-反应蛋白、白细胞水平与重症肺炎患者预后的相关性分析[J].世界临床医学,2016,10(17):458-459.
[6]徐玉辉,魏健平.血降钙素原、内毒素及中性粒细胞表面抗原CD64在重症肺炎鉴别诊断中的临床意义[J].现代医院,2017,14(1):124-127.
[7]向娟,吴佳妮,唐兵.血清降钙素原在重症肺炎治疗中的指导作用[J].首都食品与医药,2016,23(8):40-41.
[8]杨锦旺,田荣华,薛明月.降钙素原与D-二聚体动态变化在重症肺炎患者预后预测中的价值[J].现代仪器与医疗,2018,24(2):73-75.
[9]黄朋,方恋,陈波.重症肺炎患者血清降钙素原、C-反应蛋白、D-二聚体及炎症因子水平变化及其临床意义[J].安徽医药,2018,22(3):478-482.
[10]刘振国,王婷.连续性血液净化治疗对重症肺炎患者血清降钙素原水平的影响[J].实用老年医学,2016,30(2):121-124.
[11]李晓华,吕巧云,温子海.老年糖尿病伴重症肺炎患者血清炎性反应及降钙素原变化的意义[J].河北医科大学学报,2016,37(3):316-318.
[12]林桂仪,汪洁.相关指标变化对重症肺炎抗菌药物应用的指导意义[J].实用药物与临床,2016,19(7):857-860.
[13]周静,石振东.痰热清注射液治疗老年重症肺炎的临床疗效及对血清超敏C反应蛋白、降钙素原的影响[J].检验医学与临床,2017,14(11):121-123.
[14]刘红,刘培政.血清降钙素原在婴幼儿重症肺炎早期诊断中的价值[J].实用临床医药杂志,2016,20(7):105-108.
[15]岳煜,李欣,卢巧喜.清肺逐瘀汤佐治重症肺炎的疗效及对血清降钙素原的影响[J].中国临床研究,2016(9):1269-1270.
[16]郭玮,何煜婷,邵琦.联合血降钙素原、脑钠肽、D-二聚体及PCIS评分对评估儿童重症肺炎预后的价值[J].临床儿科杂志,2017,35(8):575-579.
[17]张芳芳,尹占良,邱建凯.重症肺炎患儿降钙素原与凝血纤溶指标的临床意义[J].热带医学杂志,2016,16(11):1423-1425.
[18]甘斌,黄业清,罗红伟.重症肺炎患者PCTWBCCRP水平与预后的相关性分析[J].河北医学,2016,22(12):2018-2021.
[19]陈映红,熊涛.不同炎性指标评估重症肺炎患者病情变化的临床对比研究[J].检验医学与临床,2017,14(7):926-928.
[20]李琼,张晚生,史加强,等.动态监测重症肺炎患者血清降钙素原的临床意义[J].中国实用医刊,2016,43(10):115-116.