急性腹部多发伤患者血清C反应蛋白和降钙素原对脏器损伤预后的评价意义

摘要

目的 探讨急性腹部多发伤患者血清C反应蛋白(CRP)和降钙素原(PCT)对脏器损伤预后的评价意义.方法 整理分析2015年9月至2016年12月收治的腹部多发伤患者136例的临床资料,根据是否合并多脏器功能障碍综合征(MODS),分为MODS组(n=58)和非MODS组(n=78),另选取20例同期健康体检者作为正常对照组.比较三组入院时APACHE Ⅱ评分、CRP、PCT水平差异;MODS组内死亡患者与存活患者间治疗前后CRP、PCT差异,分析MODS危险因素.结果 MODS组及非MODS组CRP、PCT明显高于正常对照组(P＜0.05),MODS组CRP、PCT水平明显高于非MODS组(P＜0.05);死亡患者入院时和治疗第7天CRP和PCT均大于存活患者(P＜0.05).PCT和CRP升高是急诊MODS的危险因素.结论 CRP和PCT联合检测可以评估急性腹部多发伤患者早期感染程度.及时控制感染,调整治疗方案对保护患者脏器功能,改善预后具有重要意义.%Objective To explore the prognostic significance of CRP and PCT level to organ damage in patients with emergency abdominal multiple trauma.Methods The clinical data of 136 patients admitted in our hospital emergency department with abdominal multiple injuries from September 2015 to December 2016 were analyzed and classified into MODS group (n =58) and non-MODS group (n =78) according to whether they had multiple organ dysfunction syndrome (MODS).Another 20 normal subjects were selected as normal control group.The differences of APACHE Ⅱ score,CRP,and PCT between the three groups were compared.The differences of CRP and PCT before and after treatment between the dead patients and survivors in MODS group were analyzed,and the risk factors of MODS were analyzed.The differences of APACHE Ⅱ score,CRP and PCT levels between the three groups were compared.The differences of CRP and PCT between the death and survivors before and after treatment in the MODS group were analyzed,and the risk factors of MODS were analyzed.Results The level of CRP and PCT in MODS group and non-MODS group were significantly higher than those in normal control group (P ＜ 0.05).The level of CRP and PCT of MODS group were significantly higher than those in non-MODS group (P ＜ 0.05).The level of CRP and PCT in death patients were higher than survivors on admission and on the 7th day of treatment (P ＜ 0.05).Elevated PCT and CRP are risk factors for emergency MODS.Conclusion The combination of CRP and PCT can assess the early stage of infection in patients with acute abdominal multiple trauma.Timely control of infection and adjustment of treatment plan are of great significance to protect the organ function and improve the prognosis of patients.