重症脓毒血症和脓毒血症休克患者早期目标导向治疗后降钙素原表达的研究

The influence of early goal-directed therapy on procalcitonin expression in severe sepsis and septic shock

目的 评价早期目标导向治疗对重症脓毒血症及脓毒血症休克患者血清降钙素原表达的影响,优化血清降钙素原对重症脓毒血症及脓毒血症休克患者病情反映与预后评估的价值.方法 跟踪调查2012年1月至2013年8月重症脓毒血症及脓毒血症休克确诊患者100例,根据所接受的治疗手段将患者分为治疗组及对照组各50例,同时根据治疗开始时患者血乳酸浓度及中心静脉血氧饱和度（ScvO2）将两组患者分重度全身组织缺氧组,中度全身组织缺氧组,全身组织氧供恢复组.监测患者基本生命体征,中心静脉血氧饱和度,中心静脉压,检测血乳酸及血清降钙素原水平,入院24内完成急性生理与慢性健康（APACHEⅡ）评分,分别比较两组患者6h检测点PCT浓度与APACHEⅡ评分的相关性.入院时及第1、2、3、7、14、21、28天进行多器官功能衰竭评分（MODS）,序贯性器官功能衰竭（SOFA）评分.统计两组患者的死亡率.结果 早期液体复苏治疗后的血清降钙素原表达水平能更好地反映患者病情及预后,差异具有统计学意义（P＜0.05）;早期液体复苏可降低重症脓毒血症及脓毒血症休克患者血清降钙素原的表达水平（P＜0.01）;早期液体复苏治疗有助于重症脓毒血症及脓毒血症休克患者病情改善及预后.结论 血清降钙素原水平与重症脓毒血症及脓毒血症休克病情预后相关;血压、血容量、全身组织氧供的早期改善治疗（EGDT）后的血清降钙素原水平能更好地反映脓毒血症病情分级及病情预后;早期目标导向治疗有助于重症脓毒血症及脓毒血症休克病情改善及预后.

Objective To evaluate the influence of early goal-directed therapy （EGDT） on procalcitonin expression in severe sepsis and septic shock, and optimize serum procalcitonin as a prognostic indicator of severe sepsis and septic shock. Methods 100 cases of severe sepsis and septic shock were collected from January 2012 to August 2013. All patients were divided into treatment group and control group according to predesigned project, 50 cases in each group; these two groups were then subdivided into three groups based on the severity of global tissue hypoxia at enrolled time point, namely severe global tissue hypoxia group [lactate ≥ 4 mmol/L and central venous oxyhemoglobin saturation （ScvO2） 〈 70%], moderate global tissue hypoxia group （2 mmol/L ≤ lactate 〈 4.0 mmol/L and ScvO2 〈 70%） and resuscitation group/resolved global tissue hypoxia group （lactate 〈 2 mmol/L and ScvO2 ≥ 70%）. Patients＇ vital signs, ScvO〉 CVP, blood lactate and serum procalcitonin were observed and recorded. Conducted acute physiology and chronic health evaluation （APACHE I ） within 24 h after enrollment, muhiple organ dysfunction score （MODS） and sequential organfailure assessment （SOFA） 1, 2, 3, 7, 14, 21 and 28 d after enrollment. Evaluated the correlation between PCT and scores. Results PCT concentration in EGDT group exemplified patients＇ conditions and prognosis better, with statistically significant difference （P 〈 0.05）. Aggressive fluid resuscitation significantly reduced serum PCT expression in patients with severe sepsis and septic shock （P 〈 0.01）, and improved patients＇ condition and prognosis. Conclusion Serum procalcitonin is correlated with progress of severe sepsis and septic shock. Aggressive improvement of hemodynamic and oxygen supply （EGDT） can protect patients with severe sepsis and septic shock, and optimize PCT as a prognosis indicator.