急诊快速PCT检测对评估脓毒症预后的意义

Application of emergency rapid PCT detection to evaluate the prognosis of sepsis

目的：探讨急诊快速Procalcitonin（PCT）检测结果对脓毒症患者病情判断及预后的意义。方法：对急诊收入ICU的61例脓毒症患者急诊首次PCT检测结果、CRP及APECHEⅡ评分进行统计学分析,根据预后分为死亡组及存活组,分析比较组间上述指标的变化及APECHEⅡ评分与PCT的相关性分析。同时按PCT水平,分为PCT〈2.0ug/L,2.0~〈10.0ug/L,PCT≥10.0ug/L 3组,比较各组的病死率和住院时间。另外,动态观察患者入院后1周PCT变化指标,并比较其与入院首次PCT质量浓度对患者预后评估的意义。结果：不同预后组的PCT、CRP与APECHEⅡ评分明显不同,死亡组的急诊PCT、CRP及APECHEⅡ评分明显高于存活组,差异有统计学意义（P〈0.05）;PCT与APACHEⅡ评分相关性分析：PCT与APACHEⅡ评分之间存在显著正相关（γ=0.85,P〈0.05）;PCT水平与病情判断及预后指标的关系：显示随着PCT值增高,脓毒症患者病死率呈增高趋势,住院时间延长。对脓毒症患者预后的评估,入院首次PCT值与PCT动态监测比较,敏感性相当,但PCT动态监测的特异性更强。结论：急诊快速PCT检测结果对脓毒症病情判断及预后评估有一定指导意义;动态监测其指标变化,对短期预后评估更具意义。

Objective：To study the effect of the rapid PCT test on the judgment of the severity and the progno- sis in patients with sepsis in the emergency department. Method：The rapid PCT test resuhs,CRP and APECHEⅡ scores were statistically analyzed in the 61 cases addmitted into ICU from emergency department. The pateints were divided into death group and alive group according to the result of the prognosis. The changes of the above in- dicators and the relationship between PCT and APECHE Ⅱ scores were analyzed in the two groups. Meanwhile, the patient＇s mortality and the hospitalization time were analyzed according to the different level of PCT（PCT〈：2. 0,2.0%〈10.0 and PCT≥10. 0 ng/mL）. Result：The rapid PCT test resuhs,CRP and APECHE Ⅱ scores were significantly different in different prognosis groups. The levels of the above indicators in the death group were higher than that in the alive group （P〈0.05）. The results of correlation analysis indicated that the PCT and A- PACHE Ⅱ score was significantly positively correlated （γ= 0.85, P〈0.05）. The relationship between the PCT and the judgment of the severity and the prognosis in patients with sepsis indicated that the higher of the level of PCT,the higher of the mortality and longer of the hospitalization time. Comparing the prognostic value of the first PCT at addmission and active mornitoring PCT,they show the similar sensitivity,but the latter with higher speci- ficity. Conclusion： The rapid PCT test may be a indicator for the judgment of the severity and the prognosis in pa- tients with sepsis.