多发伤患者早期降钙素原水平临床意义分析

Clinical significance of early serum procalcitonin level in multiple trauma patients

目的测定重症监护室中多发伤患者早期血清降钙素原(PCT)水平,分析血清PCT水平与多发伤患者创伤严重程度、创伤部位、治疗结果有无相关性,并与同期收治的脓毒血症患者血清PCT水平进行比较。方法回顾性分析2011年11月15日—2013年11月15日间复旦大学附属上海市第五人民医院创伤急救危重症医学中心重症监护室中收治的74例多发伤患者(多发伤组)的临床资料,测定其入重症监护室24h内血清PCT水平,记录并比较不同创伤部位、不同创伤严重程度评分(ISS评分)、是否行急诊手术和不同治疗结果的多发伤患者的血清PCT水平。测定同时期重症监护室中收治的57例脓毒血症患者(脓毒血症组)治疗期间的血清PCT水平,比较两组间血清PCT水平。结果多发伤患者各创伤部位的血清PCT水平由高至低依次为腹部和盆腔1.003(0.269,3.805)ng/mL、四肢和骨盆0.839(0.243,3.750)ng/mL、头颈部0.777(0.125,2.645)ng/mL、胸部0.744(0.198,2.840)ng/mL、体表0.715(0.121,2.450)ng/mL、面部0.267(0.062,2.450)ng/mL,各创伤部位间血清PCT水平的差异均无统计学意义(P值均>0.05)。ISS评分≤20分患者的血清PCT水平为0.243(0.061,0.791)ng/mL,显著低于ISS评分>20分患者的0.945(0.294,3.990)ng/mL(Z=-2.920,P<0.05)。存活患者的血清PCT水平为0.602(0.167,2.304)ng/mL,与死亡患者的1.460(0.128,22.770)ng/mL的差异无统计学意义(Z=1.053,P>0.05)。行急诊手术患者的血清PCT水平为0.772(0.128,2.450)ng/mL,与未行急诊手术患者的0.524(0.167,2.840)ng/mL的差异无统计学意义(P>0.05)。多发伤组患者的血清PCT水平为0.743(0.167,2.450)ng/mL,显著低于脓毒血症组的19.860(4.140,60.770)ng/mL(P<0.05)。结论血清PCT水平可作为评估多发伤严重程度的指标,患者创伤越严重,其血清PCT水平越高;该指标不受急诊手术的影响,可与脓毒血症相鉴别,但无法评估患者预后情况。

Objective To determine serum procalcitonin CPCT） level in patients with multiple trauma and compare it with that in patients with sepsis, and to analyze the relationship between serum POT and prognosis, injury sites and severity in multiple trauma patients. Methods A retrospective study was conducted in 74 multiple trauma patients admitted to intensive care unit of our hospital. The highest POT level of the patients in 24 hours after admission were collected and compared with the values from 57 sepsis patients treated in the same period. The patients with multiple trauma were divided into different groups according to trauma sites, injury severity score CISS）, emergency surgery and prognosis. Results In multiple trauma patients, serum POT level was 1. 003 （ 0.269, 3. 805） ng/mL in abdomen and pelvic cavity, 0. 839 （0. 243, 3. 750） ng/mL in limbs and pelvis, 0. 777 （0. 125, 2. 645） ng/mL head and neck, 0.744 （0. 198, 2. 840） ng/mL in the chest, 0.715 （0. 121, 2. 450） ng/mL in the body surface, and 0. 267 （0. 062, 2. 450） ng/mL on the face, respectively. There were no significant differences in serum POT between different injured sites （all P〈0.05）. The serum PCT level in the patients with ISS ≤ 20 was significantly lower than that in the patients with ISS〉20 C0. 243 [0. 061, 0. 791] ng/mL vs. 0. 945 E0.294, 3. 990] ng/mL, Z = -2. 920, P〈0.05）. The serum POT level in the survival patients was 0.602（0. 167, 2.304） ng/mL, which was not significantly different from that in the dead patients （1. 460 [-0. ]28, 22. 770] ng/mL, Z= 1. 053, P〉0,05）. The serum PCT level in the patients undergoing emergency surgery was 0.772 （0. 128, 2.45） ng/mL, which was not significantly different from that in the patients who did not receive emergency surgery （0. 524 [0. 167, 2,840] ng/mL, P〉0.05）. The mean value of POT in the sepsis patients was 19. 860 （4. 140, 60.770） ng/mL, which was significantly higher than that in the multiple trauma patients （0. 743 [0. 167, 2.450] ng/mL, P〈0.05）. Conclusion POT level is positively related to trauma severity and can be taken as an indicator to assess multiple trauma. POT will not be affected by emergency surgery in multiple trauma patients. Early PCT value in multiple trauma patients is lower than that in sepsis patients. There is no significant correlation between PCT level and mortality in multiple trauma patients. （Shanghai Meal J, 2014, 37 ： 1032-1036）