【摘要】 目的探讨感染性休克患者液体复苏治疗过程中血清降钙素原(PCT)、C反应蛋白(CRP)含量变化与急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分的关系。方法选择48h内液体复苏达标(CVP 8-12mm Hg,MAP≥65mm Hg)的15例感染性休克患者(休克组),采用免疫化学发光法和散射比浊法检测治疗前及治疗后24、48h血清PCT及CRP含量,行APACHEⅡ评分,分析PCT、CRP含量与APACHEⅡ评分的相关性。另选12例健康体检者作对照(对照组)。结果休克组治疗前血清PCT、CRP含量和APACHEⅡ评分高于对照组[(17.06±5.74)μg/L vs.(0.58±0.11)μg/L、(132.21±65.46)mg/L vs.(8.05±2.98)mg/L和(17.46±4.33)分vs.(6.50±1.35)分](P<0.01)。上述指标治疗后24、48h均降低(P<0.01),且治疗后48h低于治疗后24h[(8.21±4.12)μg/L vs.(9.40±3.36)μg/L、(39.68±22.26)mg/L vs.(57.21±34.56)mg/L和(8.37±4.46)分vs.(9.77±2.52)分](P<0.05)。治疗前、治疗后24h、治疗后48hAPACHEⅡ评分与PCT含量呈正相关(r=0.717、r=0.802、r=0.693,P<0.01或P<0.05),与CRP含量不相关。结论感染性休克患者血清PCT、CRP含量和APACHEⅡ评分升高,复苏过程中逐渐降低。PCT含量与APACHEⅡ评分呈较好正相关,动态监测血清PCT、CRP含量有助于评估病情和治疗。更多还原

【Abstract】 Objective To investigate the dynamic changes of serum levels of procalcitonin(PCT)and C-reactive protein(CRP)during fluid resuscitation in patients with septic shock and their correlations with acute physiology and chronic health evaluations Ⅱ(APACHEⅡ)score.Methods According to the target of resuscitation(central venous pressure 8-12 mm Hg and mean arterial pressure≥65mm Hg),15patients with septic shock(group A)received enough fluid or combined with dopamine/norepinephrine for 48hresuscitation.The serum PCT and CRP levels were measured by chemiluminescence immunoassay and immune nephelometry,respectively,and APACHEⅡ score was performed before resuscitation and at 24hand 48hafter resuscitation.The relationships of serum PCT and CRP levels with APACHEⅡ score were analyzed.Another 12healthy people were taken as the controls(group C).Results The serum PCT and CRP levels and APACHEⅡ score before resuscitation in group A were higher than those in group C[(17.06±5.74)μg/L vs.(0.58±0.11)μg/L,(132.21±65.46)mg/L vs.(8.05±2.98)mg/L and(17.46±4.33)points vs.(6.50±1.35)points](P<0.01),which were markedly decreased after resuscitation(P<0.01).All the above indexes at 48hafter resuscitation were lower than those at 24hafter resuscitation in group A[(8.21±4.12)g/L vs.(9.40±3.36)g/L,(39.68±22.26)mg/L vs.(57.21±34.56)mg/L and(8.37±4.46)points vs.(9.77±2.52)points](P<0.05).APACHEⅡscore at all time points was positively correlated with serum PCT level(r=0.717,r=0.802,r=0.693,P<0.01or P<0.05),but there was no correlation between APACHEⅡ score and serum CRP level.Conclusion High serum PCT and CRP levels and APACHEⅡ score in patients with septic shock can be decreased by optimistic resuscitation,and there is a close correlation between serum PCT level and APACHEⅡ score.Dynamic detection of serum PCT and CRP levels is helpful in the evaluation of the severity of disease and therapeutic efficacy.更多还原