血清降钙素原动态测定在胃肠穿孔性腹膜炎中的临床意义

Clinical Significance of Serum Procalcitonin Dynamic Determination in Patients with Perforation Peritonitis in Gastrointestinal Surgery

【目的】 探讨血清降钙素原(PCT)动态测定在胃肠外科穿孔性腹膜炎中的临床意义。【方法】 回顾性分析2015年1月至2017年12月本院收治的88例胃肠穿孔性腹膜炎患者的临床资料,根据是否发生细菌感染将其分为感染组(n=56)和未感染组(n=32),同时选取同期于本院体检的40名健康志愿者作为对照组。入组患者均检测血清PCT水平,比较不同组PCT水平以及不同胃肠穿孔患者临床情况。【结果】 非感染组、感染组血清PCT水平均高于对照组,差异均具有统计学意义(均P<0.05);感染组入院时,术后d1、d3、d7血清PCT水平均高于非感染组,差异均具有统计学意义(均P<0.05);非感染组、感染组术后d1血清PCT水平高于入院时,差异均具有统计学意义(均P<0.05)。肠穿孔非感染组中血液性、肠内容物性、胃液性患者入院时,术后d1、d3、d7血清PCT水平比较,差异均具有统计学意义(P<0.05);其中以胃液性腹腔积液患者的血清PCT水平最高。感染组患者住院时间、抗生素疗程、抗生素费用、住院费用、APACHE-Ⅱ评分均高于非感染组,差异具有统计学意义(P<0.05);感染组患者病死率高于对照组,但差异无统计学意义(P>0.05)。【结论】 PCT检测对评估穿孔性腹膜炎严重程度具有重要临床价值,同时对不同类型腹腔积液的诊断及鉴别提供参考依据,能够初步预测患者预后。

【Objective】 To investigate the clinical significance of serum procalcitonin dynamic determination in patients with perforated peritonitis in gastrointestinal surgery. 【Methods】 From November 2015 to November 2017, 88 cases of patients with gastrointestinal perforation were studied in our hospital. According to peritonitis, they were divided into infection group (32 cases) and non infection group (56), and 40 healthy persons were selected as normal control group. The serum levels of procalcitonin (PCT) were measured in all the patients, and the PCT levels in different groups were compared, and the clinical situation and prognosis of patients with different intestinal perforations were compared. 【Results】 The serum PCT levels in the non-infected group and the infected group were significantly higher than those in the control group (all P<0.05). The serum PCT levels in the infected group were significantly higher than those in the non-infected group on the 1st day and 3rd day after operation (all P<0.05).The level of serum PCT in the non-infection group was significantly higher than that in admission on the first day after operation (all P<0.05).In the non-infection group of intestinal perforation, there were significant differences in blood, intestinal content and gastric juice between the patients and the postoperative d1,d3,d7 serum PCT level (P<0.05).The serum PCT level in the patients with gastric and peritoneal effusion was the highest. The hospital stay time, antibiotic treatment course, antibiotic cost, hospitalization cost and APACHE-II score of the infected group were higher than that in the non-infected group (P<0.05). The case fatality rate of the infected group was higher than that of the control group, but the difference was not significant (P>0.05).【Conclusion】 PCT detection is of important clinical value in evaluating the severity of perforative peritonitis, and provides a reference for the diagnosis and identification of different types of celiac effusion, and can predict the prognosis of the patients.