高压氧对急性坏死性筋膜炎患儿血清降钙素原、白细胞和高敏C反应蛋白的影响及其疗效

Effect of hyperbaric oxygen therapy on serum PCT,WBC and hs-CRP levels in children with acute necrotizing fasciitis and its efficacy

目的探讨高压氧治疗对急性坏死性筋膜炎(necrotising fasciitis,NF)患儿血清降钙素原(procalcitonin,PCT)、白细胞(white blood cells,WBC)和高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)水平的影响及其疗效,并探讨以上指标的诊断价值。方法选取2011年3月~2014年6月在河北省儿童医院治疗的50例急性坏死性筋膜炎患者为研究组,并随机分为高压氧组(n=25)和常规组(n=25)。常规组行常规切开引流术清理病灶,高压氧组在常规组基础上接受高压氧治疗,同时选取50例健康儿童作为对照组,观察比较各组血清PCT、WBC和hs-CRP水平变化及疗效、并发症、死亡情况以及住院时间。结果研究组治疗前血清PCT、WBC和hs-CRP水平显著高于对照组(P<0.05)。PCT和hs-CRP的ROC曲线下面积均为1.000,WBC为0.804,PCT、hsCRP分别与WBC指标比较差异有统计学意义(Z=5.250、5.037,P均为0.000)。治疗后,高压氧组有23例患儿(92.00%)创面全部愈合,常规组有21例(84.00%),2组治愈率比较差异无统计学意义。高压氧组患儿出现并发症6例(24.00%)、死亡1例(4.00%),对照组出现并发症9例(36.00%)、死亡2例(8.00%),2组患儿并发症发生率和死亡率比较差异均无统计学意义。高压氧组平均住院时间为(39.17±6.73)d,明显低于常规组的(52.13±4.28)d(P<0.05)。结论 PCT和hs-CRP在诊断小儿急性坏死性筋膜炎有一定价值;切开引流与高压氧治疗小儿急性坏死性筋膜炎的临床效果较好。

Objective To investigate the effect of hyperbaric oxygen therapy on serum procalcitonin( PCT),white blood cells( WBC) and highsensitivity C-reactive protein( hs-CRP) levels in children with necrotising fasciitis( NF) and its efficacy,and explore the diagnosis value of above indicators. Methods From March 2011 to June 2014,50 cases children with acute necrotic fasciitis treated in Children's Hospital of Hebei Province as study group,which were randomly divided into hyperbaric oxygen group( n = 25) and routine group( n = 25). The routine group received the routine therapy of incision and drainage to clear the lesion,hyperbaric oxygen group received hyperbaric oxygen therapy on the basis of routine group,while 50 healthy children were selected as control group. The serum PCT,WBC,hs-CRP levels,efficacy,complications,death and hospitalization time were observed and compared. Results The serum PCT,WBC and hs-CRP levels pre-treatment in study group were higher than those in control group( P <0. 05). The area under the ROC curve of PCT and hs-CRP was 1. 000,respectively,and WBC was 0. 804,there were significant difference between PCT and WBC( Z = 5. 250,P = 0. 000),between hs-CRP and WBC( Z = 5. 037,P = 0. 000). After treatment,the wounds of 23 case patients( 92. 00%)were cured in hyperbaric oxygen group,and 21 cases in routine group( 84. 00%),there were no significant difference in cure rate between two groups. There were six cases( 24. 00%) of complications and one case( 4. 00%) of death in hyperbaric oxygen group,while nine cases( 36. 00%) of complications and two cases( 8. 00%) of death,there were no significant difference in complications rate and death rate between two groups. The hospitalization time in hyperbaric oxygen group was( 39. 17 ± 6. 73) d,which was significantly lower than( 52. 13 ± 4. 28) d in routine group( P <0. 05). Conclusion PCT and hs-CRP have certain value in diagnosis of children with acute necrotizing fasciitis; incision and drainage combined with hyperbaric oxygen therapy has a better clinical effect in the treatment of children with acute necrotizing fasciitis.