PCT、乳酸清除率及CRP与食管癌术后肺炎并ARDS预后关系

Relationship between PCT,lactate clearance,CRP and prognosis of postoperative pneumonia of esophageal cancer and ARDS

目的分析降钙素原(PCT)、乳酸清除率及C反应蛋白(CRP)与食管癌术后肺炎合并急性呼吸窘迫综合征(ARDS)患者预后的相关性。方法选取2015年1月至2019年8月本院接收的689例食管癌术后患者,其中发生肺炎者200例(A组),未发生肺炎者489例(B组)。A组中合并ARDS者86例(A1组),未合并ARDS者114例(A2组)。根据病历资料中的生存死亡情况,将A1组分为死亡组(n=34)和生存组(n=52),选取同时期680例接受健康体检结果正常者为C组。比较各间PCT、乳酸清除率及CRP水平差异,采用Logistic分析影响患者预后的独立危险因素。结果A、B、C三组PCT、CRP水平比较:A组>B组>C组,24 h乳酸清除率比较:A组<B组<C组,差异均有统计学意义(P<0.05)。A1组PCT及CRP水平比高于A2组,24 h乳酸清除率低于A2组,差异均有统计学意义(P<0.05)。生存组呼吸≥30次/min、心率≥100次/min、氧合指数<150 mmHg、呼吸困难病程≥12 h、合并多器官功能障碍综合征者及开放式手术者较死亡组少,PCT、CRP较死亡组低,24 h乳酸清除率较死亡组高,差异均有统计学意义(P<0.05)。氧合指数、呼吸困难病程、合并多器官功能障碍综合征、手术方式、PCT、CRP及24 h乳酸清除率为影响食管癌术后肺炎合并ARDS患者预后的独立危险因素(P<0.05)。结论PCT、CRP、24 h乳酸清除率三者异常表达是食管癌术后肺炎合并ARDS患者预后生存的独立危险因素,对患者的生存评估具有一定的临床价值。

Objective To analyze the correlation between the levels of procalcitonin(PCT),lactate clearance rate and C-reactive protein(CRP)and the prognosis of patients with postoperative pneumonia combined with acute respiratory distress syndrome(ARDS)after surgery for esophageal cancer.Method 689 postoperative patients with esophageal cancer treated in this hospital from January 2015 to August 2019 were selected,including 200 cases with pneumonia(group A)and 489 cases without pneumonia(group B).In group A,86 cases had ARDS(group A1),and 114 cases had no ARDS(group A2).According to the survival and death of patients in the medical records,the A1 group was divided into the death group(n=34)and the survival group(n=52).680 people who had normal result of physical examination in the same period were regarded as the group C.The differences in PCT,lactate clearance and CRP levels were compared,and the independent risk factors affecting the prognosis of patients were analyzed by Logistic.Result The levels of PCT and CRP in group A,B and C were as follows:group A>group B>group C,the 24 h lactic acid clearance rate is as follows:group A<group B<group C,and the differences were statistically significant(P<0.05).The PCT and CRP levels in the A1 group was higher than that in the A2 group,and the 24 lactate clearance rate was lower than that in the A2 group,and the differences were statistically significant(P<0.05).The survival group had fewer patients with breathings≥30 breaths/min,heart rate≥100 beats/min,oxygenation index<150 mmHg,dyspnea course≥12 h,multiple organ dysfunction syndrome and open surgery than in the death group.PCT and CRP were lower than those in the death group,and the 24 h lactate clearance rate was higher than that in the death group,and the differences were statistically significant(P<0.05).Oxygenation index,duration of dyspnea,multiple organ dysfunction syndrome,surgical methods,PCT,CRP,and 24 h lactate clearance were independent risk factors that affect the prognosis of patients with postoperative pneumonia combined with ARDS after surgery for esophageal cancer(P<0.05).Conclusion PCT,lactate clearance,and CRP of the three is an independent risk factor for the prognosis of patients with postoperative pneumonia and ARDS after esophageal cancer.It has certain clinical value for the patient’s survival assessment.