CAJ | 학술논문

目的：探讨血清降钙素原（PCT）和白细胞介素6（IL-6）联合检测在下肢长骨开放性骨折患者急诊行清创固定术和术后常规抗菌药物治疗中的临床意义。方法以下肢长骨开放性骨折伤后8～24 h，患者创口化脓、创口污染和创口无污染为标准分组，检测各组患者入院治疗前后血清 PCT、IL-6水平，并与对照组进行比较分析。结果治疗前，污染组和化脓组PCT、IL-6水平高于对照组，差异有统计学意义（P＜0．05或P＜0．01）；无污染组PCT、IL-6水平与对照组比较，差异无统计学意义（P＞0．05）。治疗后，化脓组和污染组PCT、IL-6水平呈下降趋势，无污染组PCT、IL-6水平呈波动趋势。治疗第1天，污染组和化脓组PCT、IL-6水平高于对照组，差异有统计学意义（P＜0．05或P＜0．01），与治疗前比较差异无统计学意义（P＞0．05）；无污染组PCT、IL-6水平与对照组及治疗前比较差异无统计学意义（P＞0．05）；治疗第3天，3个病例组PCT、IL-6水平均高于对照组，差异有统计学意义（P＜0．05或P＜0．01）；化脓组、污染组PCT、IL-6水平与治疗前比较差异无统计学意义（P＞0．05），无污染组PCT、IL-6水平显著高于治疗前，差异有统计学意义（P＜0．05）；治疗第5天，随病情好转PCT、IL-6水平明显下降，化脓组、污染组PCT、IL-6水平高于对照组，差异有统计学意义（P＜0．05），较治疗前水平降低，差异有统计学意义（P＜0．05）；无污染组PCT、IL-6水平高于对照组和治疗前，差异有统计学意义（P＜0．05）。结论下肢长骨开放性骨折患者合并软组织开放伤，创口易发生感染，动态监测PCT和IL-6水平，对于早期预测细菌感染、合理使用抗菌药物、促进创口和骨折愈合有一定的临床意义。
목적：탐토혈청강개소원（PCT）화백세포개소6（IL-6）연합검측재하지장골개방성골절환자급진행청창고정술화술후상규항균약물치료중적림상의의。방법이하지장골개방성골절상후8～24 h，환자창구화농、창구오염화창구무오염위표준분조，검측각조환자입원치료전후혈청 PCT、IL-6수평，병여대조조진행비교분석。결과치료전，오염조화화농조PCT、IL-6수평고우대조조，차이유통계학의의（P＜0．05혹P＜0．01）；무오염조PCT、IL-6수평여대조조비교，차이무통계학의의（P＞0．05）。치료후，화농조화오염조PCT、IL-6수평정하강추세，무오염조PCT、IL-6수평정파동추세。치료제1천，오염조화화농조PCT、IL-6수평고우대조조，차이유통계학의의（P＜0．05혹P＜0．01），여치료전비교차이무통계학의의（P＞0．05）；무오염조PCT、IL-6수평여대조조급치료전비교차이무통계학의의（P＞0．05）；치료제3천，3개병례조PCT、IL-6수평균고우대조조，차이유통계학의의（P＜0．05혹P＜0．01）；화농조、오염조PCT、IL-6수평여치료전비교차이무통계학의의（P＞0．05），무오염조PCT、IL-6수평현저고우치료전，차이유통계학의의（P＜0．05）；치료제5천，수병정호전PCT、IL-6수평명현하강，화농조、오염조PCT、IL-6수평고우대조조，차이유통계학의의（P＜0．05），교치료전수평강저，차이유통계학의의（P＜0．05）；무오염조PCT、IL-6수평고우대조조화치료전，차이유통계학의의（P＜0．05）。결론하지장골개방성골절환자합병연조직개방상，창구역발생감염，동태감측PCT화IL-6수평，대우조기예측세균감염、합리사용항균약물、촉진창구화골절유합유일정적림상의의。
Objective To explore the clinical significance of combined detection of serum procalcitonin (PCT)and interleukin 6 (IL-6 )in patients with lower limbs long bone open fractures before and after emergency debridement fixation and postoperative reg-ular antibiotics treatment.Methods Patients with lower limbs long bone open fractures within 8-24 h after injury were divided in-to wounds fester group,wounds contamination group and wounds non-contamination group.Serum PCT and IL-6 levels were detec-ted and compared between patients group and control group.Results Before treatment,PCT and IL-6 levels in wounds contamina-tion group and wounds fester group were higher than control group (P<0.05 or P<0.01),but those in wounds non-contamination group were not different with control group (P>0.05).After treatment,PCT and IL-6 levels in wounds fester group and wounds contamination group were decreased,but those in non-contamination group were with a trend of fluctuation.In the first day of treatment,PCT and IL-6 levels in contamination and fester group were higher than control group (P<0.05 or P<0.01),but there was no significant differences,compared with the levels before treatment(P>0.05).PCT and IL-6 levels in non-contamination group,compared with control group and levels before treatment,were not significantly different (P>0.05).In the third day of treatment,PCT and IL-6 levels in the three patient groups were higher than control group (P<0.05 or P<0.01).PCT and IL-6 levels in fester and contamination group were not significantly different with the levels before treatment (P>0.05).PCT and IL-6 levels in non-contamination group were significantly higher than the levels before treatment (P<0.05).In the fifth day of treat-ment,with the improvement of disease condition,PCT and IL-6 levels decreased significantly.PCT and IL-6 levels in fester and contamination group were significantly higher than control group (P<0.05),but lower than the levels before treatment (P<0.05).PCT and IL-6 levels in non-contamination group were higher than control group and the levels before treatment (P>0.05). Conclusion Wounds infection could onset in patients combined with lower limbs long bone open fractures and soft tissue open inj u-ry.Dynamic monitoring of PCT and IL-6 levels might be significant for early prediction of bacteria infection,rational use of antibi-otics and promote healing of wounds and fractures.