动态血清降钙素原检测在手术前后感染中的应用价值

The dynamic detection of serum calcitonin original in the clinical application value of infection before and after surgery

背景：近年来发现血浆降钙素原是感染的新的预警指标。目的：探讨动态血清降钙素原检测在外科手术前后感染中的临床应用价值。方法：选择外科治疗患者100例，其中甲状腺手术组25例、慢性胆囊炎组25例、急性单纯性胆囊炎组25例、急性化脓坏疽性胆囊炎组25例。在术前及术后24，72h分别采集患者静脉血标本检测血清降钙素原值、C-反应蛋白和白细胞计数，判断降钙素原水平变化与感染之间的关系。结果与结论：①甲状腺手术组在手术前后血清降钙素原水平、C-反应蛋白水平、白细胞计数无明显差异；②急性化脓坏疽性胆囊炎组术前血清降钙素原水平显著高于其他3组（P=O．01，F=125．8），与术前相比，术后降钙素原水平24h即明显下降（P=0．01，t=-3．57）；C-反应蛋白水平在术后24h不同程度的上升，72h开始下降（P=0．00，t=10．56）；③白细胞计数在急性化脓坏疽性胆囊炎组呈逐步下降，在其他3组手术前后差异无显著性意义。结果说明动态血清降钙素原水平可以较早的反映患者感染程度，且较C-反应蛋白、白细胞计数更敏感。

objective： To study the dynamic serum calcitonin original （procalcitonin, PCT） infection before and after surgery in the clinical application value. Methods： Select our 1 - December, 2013 hospitalized patients were divided into A （thyroid surgery group） and B （chronic cholecystitis group）, C （acute simple cholecystitis group）, D （acute fester gangrenous cholecystitis group） four groups, each group of 25 cases, the preoperative and postoperative 24 h, 72 h, respectively, venous blood samples collected values of serum PCT and CRP （C-reactive protein, CRP） and white blood cells, white blood cell, the WBC） count, judge the PCT level change and the relationship between the infection. Results： in group A in serum PCT and CRP levels before and after operation, no obvious difference was found between the WBC count, and group D preoperative serum PCT level is significantly higher than the other three groups （P=-0.01, F=125.8）, compared with the preoperative, postoperative PCT level 24 h is significantly decreased （P=-0.01, t=-0.01）. And CRP levels 24 h after surgery, the rise of the different level 72 h began to decline （P=0.00, t=10.56）; The WBC count in acute fester gangrenous cholecystitis grouphave been gradually falling, no detail difference before and after operation in the other three groups.Conclusion： dynamic serum PCT level can reflect the degree of infection in patients with early, and more sensitive than CRP and WBC count, can guide the clinical use of antibiotics.