炎性反应在不同病理类型急性阑尾炎围术期的比较

Comparison of inflammatory response in the perioperative period of acute appendicitis with different pathological types

目的探讨不同病理类型急性阑尾炎患者围术期的炎性反应变化及其对术前诊断的临床意义。方法回顾性分析2015年6月~2017年1月航天中心医院126例急性阑尾炎患者围术期的临床资料,对比分析急性单纯性阑尾炎(ASA,A组)、急性化脓性阑尾炎(APA,B组)、急性坏疽性阑尾炎(AGA,C组)患者术前和术后d1、d3、d5部分炎性反应指标:最高体温(HBT)、外周血白细胞计数(WBC)、中性粒细胞百分比(NE%)、外周血中性粒细胞/淋巴细胞比值(NLR)、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)。结果三组术后炎性反应指标随着时间推移逐渐降低,术后d1、d3、d5各炎性指标显著低于术前,术后d3、d5低于术后d1,且术后d5低于术后d3,差异均有统计学意义(P<0.05)。术前,C组HBT、WBC、hs-CRP、PCT明显高于A组及B组(P<0.05)。术后d1、d3、d5,A组与B组各项指标差异均无统计学意义(P>0.05)。C组术后d1、d5的WBC、NE%、hs-CRP、PCT、NLR均明显高于A组、B组,差异有统计学意义(P<0.05);C组术后d3的WBC、NLR、hs-CRP、PCT均明显高于A组、B组,差异有统计学意义(P<0.05)。结论各种炎性反应指标对急性阑尾炎的诊断起到非常重要的作用,有利于术前对AGA诊断,以便判断急性阑尾炎的病情,并作出及时处理。AGA患者术后各项炎性反应指标恢复较慢,具有较高的感染相关并发症发生率。

Objective To investigate the changes of perioperative inflammatory response in patients with different pathological types of acute appendicitis and its clinical significance for preoperative diagnosis.Methods The perioperative clinical data of 126 patients with acute appendicitis in the Aerospace Center Hospital from June 2015 to January 2017 was analyzed retrospectively.The inflammatory response indicators of patients with acute simple appendicitis (ASA,group A),acute purulent appendicitis (APA,group B) and acute gangrenous appendicitis (AGA,group C) were compared and analyzed before operation and 1,3,5 d after operation.The inflammatory response indicators included the highest body temperature (HBT),peripheral white blood count (WBC),neutrophil percentage (NE%),peripheral blood neutrophil / lymphatic ratio (NLR),high sensitivity C reactive protein (hs-CRP) and procalcitonin (PCT).Results The indicators of postoperative inflammatory reaction of the three groups decreased gradually with the passage of time.The inflammatory indicators at 1,3,5 d after operation were significantly lower than those before operation,the inflammatory indicators at 3,5 d after operation were lower than those at 1 d after operation,which at 5 d after operation were lower than those at 3 d after operation,the differences were statistically significant (P < 0.05).Before operation,HBT,WBC,hs-CRP,PCT of group C were higher than those of group A and group B (P < 0.05).The inflammatory indicators had no statistically significant differences between group A and group B at 1,3,5 d after operation (P > 0.05).The WBC,NE%,hs-CRP,PCT and NLR in group C were significantly higher than those in group A and group B at 1,5 d after operation,with statistically significant differences (P < 0.05);the WBC,NLR,hs-CRP and PCT in group C were significantly higher than those in group A and group B at 3 d after operation,with statistically significant differences (P < 0.05).Conclusion The indicators of inflammatory response play a very important role in the diagnosis of acute appendicitis and it is helpful for diagnosing AGA before operation,so as to determine the conditions of acute appendicitis and deal with the condition promptly.The inflammatory response of patients with AGA has a relatively slow recovery and a higher incidence of infection-related complications.