降钙素原对心脏直视手术预后的评估价值

Prognostic value of calcitonin in patients undergoing open-heart surgery

目的探讨降钙素原(PCT)测定在体外循环心脏直视手术预后评估中的价值。方法采用回顾性研究方法,对象选择2015年1月至9月择期行心脏直视手术的277例成人心脏病患者,测定患者术后0、1、2、3 d的PCT值,根据术后第1天PCT值将患者分为三组:A组PCT≤2.0 ng/ml,B组2.0 ng/ml<PCT<5.0 ng/ml,C组PCT≥5.0 ng/ml;比较三组患者并发症发生率、机械通气时间、ICU留治时间、病死率等指标的差异。术后24 h对患者进行急性生理学与慢性健康状况(APACHEⅡ)评分,并对术后第1天PCT与APACHEⅡ评分行相关性分析。比较死亡(8例)及非死亡患者术后PCT的动态变化。结果 277例患者中术后发生并发症88例(31.77%)。术后并发症发生率按A组(7.48%)、B组(32.29%)、C组(66.22%)顺序依次增高(P<0.05)。A组无死亡病例;B组死亡1例,为低心排血量综合征;C组死亡7例,为脓毒症1例,低心排血量综合征5例,多脏器功能障碍1例。病死率按A组(0)、B组(1.04%)、C组(9.46%)顺序依次增高(P<0.05)。机械通气时间、ICU留治时间及APACHEⅡ评分均按A、B、C组顺序依次升高(P均<0.05)。发生并发症患者中,死亡者术后PCT水平高于存活者(P<0.05,P<0.01),且在术后呈持续升高或不下降;而存活者术后2、3 d PCT逐渐下降。所有患者术后24 h PCT值[(3.41±1.28)ng/ml]与术后24 h APACHEⅡ评分(13.54±4.76)呈正相关(r=0.72,P<0.05)。结论 PCT可评估体外循环心脏术后炎症反应的严重程度,且与APACHE II评分相关性好,可作为评估心脏术后预后的较可靠指标。

Objective To investigate the value of procalcitonin（ PCT） detection for assessing prognosis of cardiac operation under direct vision by cardiopulmonary bypass. Method The retrospective study was performed on 277 adult patients with heart disease who underwent time-selective open heart surgery in Gaozhou People’s Hospital from January to September2015. Blood samples were taken at 0-,1-,2-,3- day after operation for detecting levels of PCT. The patients were divided into three groups based on PCT levels of postoperative first day： group A（ PCT≤2. 0 ng / ml）,group B（ 2. 0 ng / ml 〈 PCT 〈5. 0 ng / ml） and group C（ PCT≥5. 0 ng / ml）. The incidence of complications,mechanical ventilation time,ICU retention time,mortality and other indicator were compared among three groups. Acute physiology and chronic health evaluation（ APACHE II） scoring were performed 24 hours after operation,and the correlation between APACHE II score and PCT level of postoperative first day was studied. The dynamic changes of PCT level were compared between death patients and non-death patients. Results The incidence of postoperative complications was 31. 77%,and it rose in turn according to the order of group A（ 7. 48%）,group B（ 32. 29%）,group C（ 66. 22%,P 〈 0. 05）. There was no death case in group A; in group B,1 case died from low cardiac output syndrome; in group C,7 cases died respectively from sepsis（ 1 case）,low cardiac output syndrome（ 5 cases） and multiple organ dysfunction syndrome（ 1 case）. The case-fatality rates rose in turn according to the order of group A（ 0）,group B（ 1. 04%） and group C（ 9. 46%,P 〈 0. 05）. The mechanical ventilation time,ICU retention time and APACHE II score increased significantly sequentially from group A to group C（ P 〈 0. 05）. In patients with complications,postoperative PCT levels in dead cases were higher than that in survival cases（ P 〈 0. 05,P 〈0. 01）,and the PCT level in dead cases continuously increased after operation or kept on the high levels,while the PCT level in survival cases decreased gradually at 2- or 3-day after operation. At 24 h after operation,the PCT level [（ 3. 41 ±1. 28） ng / ml] was positively correlated with APACHE II score（ 13. 54 ± 4. 76,r = 0. 72,P 〈 0. 05） in all patients. Conclusion PCT can evaluate the severity of inflammatory response after open-cardiac surgery and its correlation with APACHE II score is good. It can be used as a more reliable indicator evaluating the prognosis after cardiac surgery.