早期监测下肢长骨开放性骨折患者血清PCT和IL-6的临床意义

Clinical significance of early monitoring of serum PCT and IL-6 in patients with lower limbs long bone open fractures

目的：探讨血清降钙素原（PCT）和白细胞介素6（IL-6）联合检测在下肢长骨开放性骨折患者急诊行清创固定术和术后常规抗菌药物治疗中的临床意义。方法以下肢长骨开放性骨折伤后8∽24 h，患者创口化脓、创口污染和创口无污染为标准分组，检测各组患者入院治疗前后血清 PCT、IL-6水平，并与对照组进行比较分析。结果治疗前，污染组和化脓组PCT、IL-6水平高于对照组，差异有统计学意义（P＜0．05或P＜0．01）；无污染组PCT、IL-6水平与对照组比较，差异无统计学意义（P＞0．05）。治疗后，化脓组和污染组PCT、IL-6水平呈下降趋势，无污染组PCT、IL-6水平呈波动趋势。治疗第1天，污染组和化脓组PCT、IL-6水平高于对照组，差异有统计学意义（P＜0．05或P＜0．01），与治疗前比较差异无统计学意义（P＞0．05）；无污染组PCT、IL-6水平与对照组及治疗前比较差异无统计学意义（P＞0．05）；治疗第3天，3个病例组PCT、IL-6水平均高于对照组，差异有统计学意义（P＜0．05或P＜0．01）；化脓组、污染组PCT、IL-6水平与治疗前比较差异无统计学意义（P＞0．05），无污染组PCT、IL-6水平显著高于治疗前，差异有统计学意义（P＜0．05）；治疗第5天，随病情好转PCT、IL-6水平明显下降，化脓组、污染组PCT、IL-6水平高于对照组，差异有统计学意义（P＜0．05），较治疗前水平降低，差异有统计学意义（P＜0．05）；无污染组PCT、IL-6水平高于对照组和治疗前，差异有统计学意义（P＜0．05）。结论下肢长骨开放性骨折患者合并软组织开放伤，创口易发生感染，动态监测PCT和IL-6水平，对于早期预测细菌感染、合理使用抗菌药物、促进创口和骨折愈合有一定的临床意义。

Objective To explore the clinical significance of combined detection of serum procalcitonin （PCT）and interleukin 6 （IL-6 ）in patients with lower limbs long bone open fractures before and after emergency debridement fixation and postoperative reg-ular antibiotics treatment.Methods Patients with lower limbs long bone open fractures within 8-24 h after injury were divided in-to wounds fester group,wounds contamination group and wounds non-contamination group.Serum PCT and IL-6 levels were detec-ted and compared between patients group and control group.Results Before treatment,PCT and IL-6 levels in wounds contamina-tion group and wounds fester group were higher than control group （P〈0.05 or P〈0.01）,but those in wounds non-contamination group were not different with control group （P〉0.05）.After treatment,PCT and IL-6 levels in wounds fester group and wounds contamination group were decreased,but those in non-contamination group were with a trend of fluctuation.In the first day of treatment,PCT and IL-6 levels in contamination and fester group were higher than control group （P〈0.05 or P〈0.01）,but there was no significant differences,compared with the levels before treatment（P〉0.05）.PCT and IL-6 levels in non-contamination group,compared with control group and levels before treatment,were not significantly different （P〉0.05）.In the third day of treatment,PCT and IL-6 levels in the three patient groups were higher than control group （P〈0.05 or P〈0.01）.PCT and IL-6 levels in fester and contamination group were not significantly different with the levels before treatment （P〉0.05）.PCT and IL-6 levels in non-contamination group were significantly higher than the levels before treatment （P〈0.05）.In the fifth day of treat-ment,with the improvement of disease condition,PCT and IL-6 levels decreased significantly.PCT and IL-6 levels in fester and contamination group were significantly higher than control group （P〈0.05）,but lower than the levels before treatment （P〈0.05）.PCT and IL-6 levels in non-contamination group were higher than control group and the levels before treatment （P〉0.05）. Conclusion Wounds infection could onset in patients combined with lower limbs long bone open fractures and soft tissue open inj u-ry.Dynamic monitoring of PCT and IL-6 levels might be significant for early prediction of bacteria infection,rational use of antibi-otics and promote healing of wounds and fractures.