摘要
目的:评价血降钙素原(PCT)在体外循环心脏术后早期并发症中的预测价值。方法:126例体外循环心脏术后患者,于术后24 h检测血PCT、C反应蛋白(CRP)、IL-6、IL-8、TNF-α,并进行急性生理学与慢性健康状况(APACHEⅡ)评分及SOFA评分。按是否出现并发症分为并发症组与对照组,比较2组间各项指标是否存在差异,并将各项炎性指标与APACHEⅡ评分及SOFA评分行相关性分析。结果:并发症组56例,对照组70例。并发症组手术时间[(281±49)min vs(237±51)min]、体外循环时间[(138±35)min vs(116±39)min)]及主动脉阻断时间[(83±22)min vs(62±18)min]均显著长于对照组。并发症组PCT、IL-6、IL-8、TNF-α、APACHEⅡ评分均显著高于对照组(均P<0.05),而CRP无明显差异。PCT、IL-6、IL-8、TNF-α与APACHEⅡ评分、SOFA评分均呈明显正相关,其中PCT与APACHEⅡ评分及SOFA评分相关性最高(r=0.87、0.92,P<0.05)。CRP与APACHEⅡ评分及SOFA评分无相关性。结论:PCT值可作为评价体外循环心脏术后早期病情严重程度及预后的参考指标。
Objective: To explore the predictive value of procalcitonin( PCT) in the early complication after cardiopulmonary bypass( CPB). Methods: Blood samples were taken from 126 cases 24 hours after CPB for detecting levels of PCT,C-reactive protein( CRP),interleukin( IL)-6,IL-8 and tumor necrosis factor-α( TNF-α). APACHEⅡ score and SOFA score were recorded at same time. Patients were divided into complication group and control group according to the occurence of complications or not. All indexes were compared between the two groups,and then the relationship with APACHEⅡ score and SOFA score were analyzed. Results: 56 patients who occurred complications after CPB were as the complication group and the other 70 patients were arranged to the control group. The duration of operation [( 281 ± 49) min vs 237 ± 51) min],duration of CBP [( 138 ± 35) min vs( 116 ± 39) min]and the time of aortic clamping [( 83 ± 22) min vs( 62 ± 18) min]in complication group were significantly longer than those of control group. The levels of PCT,IL-6,IL-8,TNF-α and APACHE Ⅱscore in patients with complications after operation were significantly higher than those of control group( P <0. 05),but CRP showed no significant changes. The 1evels of PCT,IL-6,IL-8,TNF-a were positively correlated with APACHE Ⅱ score and SOFA score,especially PCT( r = 0. 87,0. 92 P < 0. 05). CRP is not correlated with APACHE Ⅱscore and SOFA score. Conclusions: PCT detection is an early,specific and sensitive diagnostic method to identify high-risk patients after cardiac surgery.
引文
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