脊柱内固定手术前后CRP、ESR的动态变化及其临床意义

The regularity of the levels of CRP and ESR in patients before and after operation of spinal internal fixation and their clinical significance

目的观察CRP及ESR在脊柱内固定手术前后的一般变化规律,并探讨其在感染监测中的临床意义。方法选择行脊柱内固定手术的患者98例,其中并发脊柱深部切口感染7例。在术前1天、术后1、3、7、14、21、28天检测CRP及ESR。对于并发脊柱深部切口感染患者,28天后继续每周检测CRP及ESR,直至感染控制,CRP正常。同时记录患者性别、年龄、疾病类型、手术部位、手术时间、是否输血等可能影响CRP及ESR数值变化的因素。结果 CRP在脊柱内固定术后3日达峰值,为86.80 mg/L,然后快速下降,一般在术后14日降至正常,为6.76 mg/L。ESR在脊柱内固定术后7日达峰值,为64.93 mm/h,然后缓慢下降,但术后28日仍高于正常,为20.46 mm/h。术后不同手术部位的CRP动态变化趋势一致,均在术后3日达峰值,术后14日逐渐降至正常,但同时期在胸椎及胸腰段的CRP均值峰值相应高于颈椎及腰椎部位。脊柱术后早期深部感染患者与一般无感染患者相比,其CRP峰值后移,术后7日峰值(136.5 mg/L)高于术后3日(117.31 mg/L),而且回落至正常时间推迟,术后14日(39.93 mg/L)仍高于正常。随感染控制,在术后42日降至正常(6.02 mg/L)。ESR在脊柱术后早期深部感染患者高峰在术后7日出现,但其峰值更高,达106 mm/h,下降幅度小,持续偏高,在术后42日仍高于正常,为43mm/h。结论动态观察CRP及ESR有助于早期发现脊柱内固定术后感染,从而早期治疗。对于肥胖、老年人及糖尿病患者,为术后感染高危人群,动态检测CRP及ESR尤为必要。

Objective To observe the regularity of the levels of C-reactive protein （CRP） and erythrocyte rates （ESR） in patients before and after operation of spinal internal fixation, and to study their clinical significance. Methods CRP and ESR were determined in 98 patients before the first day of operation and in the first, third, seventh, fourteenth, twenty-first, twenty-eighth day after oper- ation. For 7 patients with pestsurgical deep incision infection induced by spinal internal fixation, CRP and ESR were determined every week till CRP was normal and infections were controlled. And some possible correlation factors such as sex, age, disease type, surgical site, operation time and blood transfusion or not were recorded, which may affect the levels of CRP and ESR. Results CRP level increased rapidly after operation, peaked at day 3 （86.80 mg/L）,and dropped quickly to normal at day 14 （6.76mg/L）. ESR level increased slowly after operation, peaked at day 7（64.93 mm/h）, and dropped gradually, still abnormal at day 28（20.46 mm/h）. The dynamic trends of CRP in different surgical site were consistent, peaked at day 3 and dropped quickly to normal at day 14. But the peak value of CRP in the thoracic and thoracolumbar was higher than that in the cervical and lumbar spine at the same period. The CRP peak in early postsurgical deep incision infection moved back, compared with the general non-infected patients, peaked at day 7 （136.5 mg/L）after operation, which was higher than that of day 3 （117.31 mg/ L）, and fell back to normal time delayed, which was still higher than normal after 14 days （39.93 mg/L）. ESR in the early infection peak oecured at 7 days after surgery, but its peak higher, up to 106 mm/h, a small decline, remained high after surgery 42 days（43 mm/h）. Conclusion Dynamic observation of CRP and ESR ean help diagnose early postsurgical deep incision infection induced by spinal internal fixation and provide early treatment. CRP and ESR dynamic testing is particularly necessary for those obesity, the elderly, patients with diabetes, who are high risks for infection.