血中性粒细胞监测在经皮肾镜取石术并发感染性休克预警价值的研究
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摘要
目的:观察经皮肾镜取石术(percutaneous nepholithotomy,PCNL)并发感染性休克血中性粒细胞变化特点,探讨血中性粒细胞监测在早期诊断感染性休克的价值,为临床诊断提供预警指标。方法:对我院2013年6月至2015年12月6例行PCNL术后并发感染性休克的临床资料进行研究,分析术后2 h、术后6 h,术后24 h,术后第3 d和术后第7 d血中性粒细胞计数和降钙素原值,观察血中性粒细胞计数和降钙素原值变化,运用多次重复测量方差分析。结果:PCNL并发感染性休克的患者术后血中性粒细胞呈现出先急剧下降后上升最后恢复正常的特点。6例患者2 h内血中性粒细胞较术前急剧下降。6 h血中性粒细胞较术前上升,术后24 h术前相比明显升高,术后第3 d较下降,第7 d基本正常;血降钙素原呈现出迅速上升最后恢复正常的特点。术后6 h上升为严重感染指示(≥10 ng·mL~(-1)),上升到术后第3 d后开始下降。外周血白细胞计数与降钙素组间时间差异均有统计学意义(P <0. 05)。相对降钙原的变化,血中性粒细胞变化更早出现,敏感性更高。结论:PCNL患者术后并发感染性休克时血中性粒细胞2 h内急剧下降,可作为临床并发感染性休克的预警提示。
Objective: To access the value of neutrophil on prediction of septic shock of postoperative percutaneous nepholithotomy( PCNL). Method: From Jun. 2013 to Dec,2015,the clinical data of 6 case undergoing PCNL were retrospective analyzed,All cases were diagnosed with septic shock after operation. Routine blood and procalcitonin were detected at postoperative 2 h,6 h,12 h,3 d and 7 d. Result: The blood neutrophil showed a rapid decline and then increased,and finally returned to normal level in 6 cases. The blood neutrophil in 2 hours after operation was significantly decreased compared to preoperative blood neutrophil. Then data of blood neutrophil increased steadily in 6 hours after operation and climbed to the peak in 12 hours after operation. On the 3 rd day those began to decrease and was normal on the seventh day. Blood procalcitonin showed rapid rise and finally returned to normal after operation,data began to rise to an abnormal value( > 0. 5 ng·mL~(-1)) in 2 hours after operation,then severe infection were detected( indicating increased more than 10 ng·m L-1) in 6 hours after surgery,then blood procalcitonin climbed to the peak in 3 rd day after operation and began to go back to the normal range. Conclusion: Neutrophil is a sensitive indicator of septic shock following PCNL when it rapidly declines to abnormal value in 2 hours after operation.
Objective: To access the value of neutrophil on prediction of septic shock of postoperative percutaneous nepholithotomy( PCNL). Method: From Jun. 2013 to Dec,2015,the clinical data of 6 case undergoing PCNL were retrospective analyzed,All cases were diagnosed with septic shock after operation. Routine blood and procalcitonin were detected at postoperative 2 h,6 h,12 h,3 d and 7 d. Result: The blood neutrophil showed a rapid decline and then increased,and finally returned to normal level in 6 cases. The blood neutrophil in 2 hours after operation was significantly decreased compared to preoperative blood neutrophil. Then data of blood neutrophil increased steadily in 6 hours after operation and climbed to the peak in 12 hours after operation. On the 3 rd day those began to decrease and was normal on the seventh day. Blood procalcitonin showed rapid rise and finally returned to normal after operation,data began to rise to an abnormal value( > 0. 5 ng·mL~(-1)) in 2 hours after operation,then severe infection were detected( indicating increased more than 10 ng·m L-1) in 6 hours after surgery,then blood procalcitonin climbed to the peak in 3 rd day after operation and began to go back to the normal range. Conclusion: Neutrophil is a sensitive indicator of septic shock following PCNL when it rapidly declines to abnormal value in 2 hours after operation.
引文
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[17]李贵忠,满立波,王海,等.比较降钙素原、C反应蛋白和血白细胞计数在经皮肾镜取石术后脓毒症诊断中的价值[J].中华泌尿外科杂志,2017,38(1):42-46.
[18] Amano T,Matsui F,Takashima H,et al. Analysis of patients with septic shock due to urosepsis brought on by ureteral calculi[J]. Hinyokika Kiyo,2003,49(1):1-4.
[2]那彦群,叶章群,孙光,等.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社,2014:296-298.
[3]梁阳冰,覃斌,黄向华,等.经皮肾镜术后并发感染性休克及多器官功能障碍综合征的预警指标研究及防治对策[J].中国生化药物杂志,2015,36(5):159-161.
[4]魏武,葛京平,马宏青,等.经皮肾镜钬激光碎石术全身炎症反应综合征发生的相关因素[J].临床泌尿外科杂志,2007,22(4):264-266,269.
[5]张建华,官润云,龙江,等.上尿路腔内碎石术后并发感染性休克的处理和预防[J].临床泌尿外科杂志,2009,24(3):171-172,175.
[6]李炯明,谢平波.经皮肾镜取石术严重并发症的预防和处理[J].现代泌尿外科杂志,2014,19(6):356-360.
[7]吴海洋.上尿路腔内碎石术致急性感染性休克的早期预警研究[D].杭州:浙江大学,2012.
[8] Adelais G,Tsiotou,George H,et al. Septic shock; current pathogenetic concepts from a clinical perspective[J].Med Sci Monit,2005,11(3):RA76-85.
[9] Dellinger R P,Levy M M,Rhodes A,et al. Surviving sepsis campaign:International guidelines for management of severe sepsis and septic shock:2012[J]. Crit Care Med,2013,41(2):580-637.
[10] Grabe M. Controversies in antibiotic prophylaxis in urology[J]. Int J Antimicrob Agents,2004,23(Suppl 1):S17-23.
[11] Aaron M P,Alyssa M P,Tyler M B,et al. Is extended preoperative antibiotic prophylaxis for high-risk patients necessary before percutaneous nephrolithotomy?[J]. Investig Clin Urol,2016,57(6):417-423.
[12]刘丹,乔庐东,陈山.尿路结石术前应用抗菌药物治疗的指征是什么?[J].现代泌尿外科杂志,2015,20(1):55-57.
[13]尹文,李俊杰.感染性休克发病机制的研究进展[J].中国急救医学,2015,35(3):197-202.
[14] Kumar A,Roberts D,Wood K E,et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock[J]. Crit Care Med,2006,34(6):1589-1596.
[15]邓家栋.邓家栋临床血液学[M].上海:科学技术出版社,2001:798-800.
[16]卞崔冬,黄盛松,廖国强,等.降钙素原监测对上尿路结石术后感染性休克早期诊治的价值[J].外科研究与新技术,2015,4(3):145-148.
[17]李贵忠,满立波,王海,等.比较降钙素原、C反应蛋白和血白细胞计数在经皮肾镜取石术后脓毒症诊断中的价值[J].中华泌尿外科杂志,2017,38(1):42-46.
[18] Amano T,Matsui F,Takashima H,et al. Analysis of patients with septic shock due to urosepsis brought on by ureteral calculi[J]. Hinyokika Kiyo,2003,49(1):1-4.