血清降钙素原(PCT)测定在儿童感染性疾病中的应用

The Clinical Significance of Serum Procalcitonin in the Iinfectious Diseases in Children Patients

目的:探讨血清降钙素原检测在儿童感染性疾病中的应用价值。方法:90例住院患儿分为脓毒血症组、菌血症组、局部细菌感染组和非细菌(病毒)感染组,20例正常查体作为对照。采用半定量固相免疫测定法测定血清PCT,同时免疫散射比浊法测定血清C反应蛋白(CRP),常规方法检测白细胞(WBC)。结果:90例患儿中,细菌感染组血清PCT、CRP和WBC阳性率分别为90.0%、84%和36.0%,非细菌感染组阳性率分别为5.0%、72.5%和7.5%,细菌感染组血清PCT阳性率显著高于非细菌感染组,CRP差异不显著,WBC阳性率明显低于PCT。脓毒血症组、菌血症组、局部细菌感染组血清CRP阳性率分别为100%、92.5%和87.5%,阳性率与细菌感染程度成正比。PCT升高程度与患儿住院时间成正比。结论:患儿血清PCT检测是区分细菌感染和非细菌感染的重要指标,明显优于CRP和WBC检测,PCT与感染程度呈正相关,同时可作为疗效和预后评估指标。

Objective： To compare the effect of a continuous femoral nerve block with an additional periarticular injection on postoperative analgesia and knee rehabilitation after total knee arthroplasty（TKA）.Methods： In this prospective,randomized controlled study,40 ASA physical statusⅠ-Ⅱpatients scheduled for selective primary unilateral total knee arthroplasty under spinal anesthesia（SA） were selected.All patients received a standard continuous femoral nerve block（0.2% ropivacaine,6 ml/h） and the stimulating catheters remained indwelling for 72 hours after operation.The patients were allocated into two groups.In the wards,patiens in GroupⅠwere maintained by periarticular injection of 0.25% ropivacaine and 5 mg dexamethasone injection（20 mL in total）.GroupⅡwere maintained by 20 mL normal saline.Results： The 2 treatment groups had similar WOMAC and HSS scores for the mean area.Mean maximal VAS scores during physical therapy were significantly lower among patients who received periarticular injection versus placebo（VAS： PO8hr,12hr p-value0.01,POD1 p-value0.05）.The maximal continuous passive motion amplitude of periarticular injection were significantly larger than that of placebo group（CPM amplitude： POD 2,p-value0.01,POD3 p-value0.05）.There were no complications resulting from the technique and the level of patient satisfication was high.Conclusions： A femoral nerve block combined with periarticular injection attenuates pain more effectively and is associated with better knee rehabilitation.