降钙素原浓度监测在心脏停搏后综合征患者早期救治中的价值和意义

The clinical significance of monitoring procalcitonin concentration in early treatment for patients with post-cardiac arrest syndrome

目的观察心脏停搏后综合征（PCAS）患者早期降钙素原（PCT）浓度的动态变化，探讨PCT水平对PCAS患者救治的临床价值和意义。方法回顾性分析东莞市第五人民医院重症医学科2012年1月至2014年12月收治的73例PCAS患者的临床资料，以心肺复苏（CPR）后当天的PCT水平分为类脓毒症组（PCT≥10μL，46例）和非类脓毒症组（PCT〈10μg/L，27例），比较两组入院7d感染发生率。以入院7d内是否并发感染分为感染组（17例）和非感染组（56例），比较两组入院当天的PCT水平。以28d预后分为存活组（50例）和死亡组（23例），比较两者间PCT的变化，并对所有患者进行急性生理学与慢性健康状况评分系统Ⅱ（APACHEH）评分，分析PCT与APACHEⅡ评分的相关性。结果入院当天类脓毒症组感染发生率与非类脓毒症组差异无统计学意义[23．9％（11／46）比22．2％（6／27），P〉0．05]；感染组与非感染组PCT水平差异无统计学意义[μL：16．80（7．85，38．80）比9．30（1．48，31．15），P〉0．05]；死亡组PCT明显高于存活组[μL：33．20（32．00，46．00）比5．12（0．50，16．35），P〈0．01]，死亡组和存活组随时间延长开始升高，并于入院1d时达峰值[58．30（47．26，76．40）和8．75（1．22，30．87）]，然后缓慢下降，但死亡组较存活组下降缓慢，5d起降到正常水平，6d时死亡组PCT仍明显高于存活组[1．20（1．02，6．40）比0．46（0．05，1．20），P〈0．01]。Pearson相关分析显示：PCT与APACHEⅡ评分呈正相关性（r=0．447，P〈0．01）。结论早期动态监测PCT水平对指导判断PCAS患者的病情严重程度及预后有一定的作用，但PCAS患者早期PCT浓度升高与感染相关性差，不能单纯根据PCT来判断PCAS患者早期发生感染。

Objective To investigate the early monitoring dynamic changes of procalcitonin （PCT） level in patients with post-cardiac arrest syndrome （PCAS） and to approach the clinical value and significance of the monitoring in saving such patients. Methods A retrospective study on clinical historical data of 73 patients with PCAS admitted to the Department of Critical Care Medicine of the Fifth People＇s Hospital of Dongguan, Dongguan Hospital Affiliated to Medical College of Jinan University from January 2012 to December 2014 were investigated. The patients were divided into a sepsis-like group （PCT ≥ 10μg/L, 46 cases） and a non-sepsis-like group （PCT 〈 10μg/L, 27 cases） according to the PCT on the day after the cardio-pulmonary resuscitation （CPR） carried out; the incidence of infection within 7 days after admission and situation of using drugs for anti-infection were compared between the two groups. They were divided into an infective group （17 cases） and a non-infective group （56 cases） according to whether the patient was complicated by infection or not within 7 days after admission, and the PCT levels on the day of admission in the two group were compared. The patients were divided into survivor （50 cases） and non-survivor （23 cases） groups according to the prognosis within 28 days, the changes of PCT level in two groups were compared, the acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score was evaluated for all the patients, and the correlation between PCT and APACHE lI score was analyzed. Results The incidence of infection between the sepsis-like group and the non-sepsis-like group was of no statistical significant difference [23.9% （11/46） vs. 22.2% （6/27）, P 〉 0.05]. The difference between PCT levels on the day of admission in the infective group and non-infective group was of no statistical significance [μg/L： 16.80 （7.85, 38.80） vs. 9.30 （1.48, 31.15）, P 〉 0.05]; in non-survivor group, the PCT level was obviously higher than that in survivor group [ μg/L： 33.20 （32.00, 46.00） vs. 5.12 （0.50, 16.35）, P 〉 0.01], in the non- survivor and survivor groups, the PCT level began to increase with the extension of time and it reached a peak value on the 1st day after admission [ μg/L： 58.30 （47.26, 76.40） vs. 8.75 （1.22, 30.87）], then decreased slowly, but the PCT levelin non-survivor group was decreased more slowly than that in survivor group, beginning from the 5th day, it decreased to normal level, on the 6th day the PCT level in non-survivor group was still higher than that in survivor group [ μg/L： 1.20 （1.02, 6.40） vs. 0.465 （0.05, 1.20）, P 〈 0.05]. Pearson correlation analysis showed： PCT and APACHE Ⅱ score was positively correlated （r = 0.447, P 〈 0.01）. Conclusions Early dynamic monitoring PCT concentration has certain effect on guidance and estimation of the disease severity and prognosis in patients with PCAS, but the elevation of PCT level at early stage in such patients was poorly associated with the incidence of infection, and simply based on the level of PCT to judge whether the early infection occurring or not in PCAS palients is not reliable.