血清降钙素原在上尿路腔内碎石术后脓毒血症诊治中的应用研究

Clinical value of procalcitonin in diagnosis and treatment of sepsis after endoscopic lithotripsy for upper urinary tract stones

目的探讨血清降钙素原（PCT）在上尿路腔内碎石术后脓毒血症（SG）及脓毒性休克（SSG）早期诊断，提高抗菌药物合理使用和降低耐药率的价值。方法回顾性分析2008年1月-2013年4月医院764例微创经皮肾镜取石术（PCNL）及1137例输尿管镜碎石取石（URL）术中、术后发生严重感染患者临床资料；PCT2～5ug／L给予头孢哌N／舒巴坦治疗；PCT持续升高或≥5μg／L则选用碳青霉烯类抗菌药物治疗，同时积极复苏、支持、去除合并因素等抗休克治疗，每日监测PCT，数据经SPSS14．0软件进行统计分析处理。结果发生感染性全身炎症反应综合征（SIRS）13例，发生率0．68％，其中发生SG9例，发生率0．47％，SSG4例，发生率0．21％；SSG患者血清PCT均明显高于SG（P〈0．05）；10例白细胞〈4×10^9／L；2例感染中毒性休克发生于术后2～3hPcT〉10μg／L，13例SIRS患者经治疗后均恢复正常。结论PCT监测对于上尿路腔内碎石术后SG早期诊断、抗菌药物合理使用、疗效判断及降低耐药率具有重要价值；根据PCT感染指标应用疗效确切的广谱抗菌药物对于严重SG及SSG病程转归至关重要。

OBJECTIVE To study the clinical value of procalcitonin （PCT） in early diagnosis of sepsis group（SG） and septic shock group （SSG） after endoscopic lithotripsy for upper urinary tract stones so as to improve the reasonable use of antibiotics and reduce the drug resistance rate. METHODS From Jan 2008 to Apr 2013, the clinical data of 764 patients with intraoperative infections and postoperative infection undergoing minimally invasive percutaneous nephrolithotomy lithotomy and 1137 patients with intraoperative infections and postoperative infections undergoing ureteroscopy lithotripsy were retrospectively analyzed; the patients with the PCT varying between 2 and 5μg/L were treated with the cefoperazone-sulbactam, while the subjects with the elevated PCT or the PCT level higher than 5μg/L were given the carbapenems, meanwhile the anti-shock therapy including the recovery, support, and removal of combined factors were actively performed, the daily monitoring of PCT was carried out, and the statistical analysis was performed with the use of SPSS14. 0 software. RESULTS The infectious systemic inflammatory response syndrome （SIRS） occurred in 13 cases with the incidence rate of 0.68%, including 9 （0.47%） cases of SG and 4 （0.21%） cases of SSG; the serum PCT level of the SSG patients was significantly higher than that of the SG patients; there were 10 cases with the white blood cell counts less than 4×10^9/L; the septic shock occurred in 2 eases at 2-3 hours after the surgery, with the PCT level higher than 10μg/L, and all the 13 cases of SIRS were cured after the treatment. CONCLUSION The monitoring of PCT has significant value in the early diagnosis of SG after endoscopic lithotripsy for upper urinary tract stones, reasonable use of antibiotics, judgment of curative effect, and reduction of drug resistance rate~ it is crucial for the prognosis of severe SG and SSG to use definite broad spectrum antibiotics according to the PCT indicators for infections.