血中性粒细胞监测在经皮肾镜取石术并发感染性休克预警价值的研究

The value of neutrophil on prediction of septic shock of postoperative percutaneous nepholithotomy

目的:观察经皮肾镜取石术(percutaneous nepholithotomy,PCNL)并发感染性休克血中性粒细胞变化特点,探讨血中性粒细胞监测在早期诊断感染性休克的价值,为临床诊断提供预警指标。方法:对我院2013年6月至2015年12月6例行PCNL术后并发感染性休克的临床资料进行研究,分析术后2 h、术后6 h,术后24 h,术后第3 d和术后第7 d血中性粒细胞计数和降钙素原值,观察血中性粒细胞计数和降钙素原值变化,运用多次重复测量方差分析。结果:PCNL并发感染性休克的患者术后血中性粒细胞呈现出先急剧下降后上升最后恢复正常的特点。6例患者2 h内血中性粒细胞较术前急剧下降。6 h血中性粒细胞较术前上升,术后24 h术前相比明显升高,术后第3 d较下降,第7 d基本正常;血降钙素原呈现出迅速上升最后恢复正常的特点。术后6 h上升为严重感染指示(≥10 ng·mL^(-1)),上升到术后第3 d后开始下降。外周血白细胞计数与降钙素组间时间差异均有统计学意义(P <0. 05)。相对降钙原的变化,血中性粒细胞变化更早出现,敏感性更高。结论:PCNL患者术后并发感染性休克时血中性粒细胞2 h内急剧下降,可作为临床并发感染性休克的预警提示。

Objective： To access the value of neutrophil on prediction of septic shock of postoperative percutaneous nepholithotomy（PCNL）. Method： From Jun. 2013 to Dec, 2015,the clinical data of 6 case undergoing PCNL were retrospective analyzed, All cases were diagnosed with septic shock after operation. Routine blood and procalcitonin were detected at postoperative 2 h,6 h,12 h,3 d and 7 d. Result： The blood neutrophil showed a rapid decline and then increased, and finally returned to normal level in 6 cases. The blood neutrophil in 2 hours after operation was significantly decreased compared to preoperative blood neutrophil. Then data of blood neutrophil increased steadily in 6 hours after operation and climbed to the peak in 12 hours after operation.On the 3rd day those began to decrease and was normal on the seventh day. Blood procalcitonin showed rapid rise and finally returned to normal after operation, data began to rise to an abnormal value （〉0.5 ng·mL -1 ） in 2 hours after operation, then severe infection were detected （indicating increased more than 10 ng·mL -1 ） in 6 hours after surgery, then blood procalcitonin climbed to the peak in 3rd day after operation and began to go back to the normal range. Conclusion： Neutrophil is a sensitive indicator of septic shock following PCNL when it rapidly declines to abnormal value in 2 hours after operation.