CAJ | 학술논문

目的确定胃手术后患者血降钙素原(procalcitonin,PCT)值的影响因素,评估以血PCT值判断胃手术后患者发生感染性并发症的作用.方法从2011年6月至2013年1月,将非连续的153例行胃手术的患者纳入研究,记录其在手术第1、3、7天的体温、血PCT、外周血白细胞计数及中性粒细胞比例,分析影响术后血PCT值的因素,并分别研究其判断感染性并发症的能力.结果术后并发症、手术类型和行急诊手术对术后第1天的血PCT值有一定程度的影响,而术后第3天和第7天血PCT值的影响因素均为术后并发症.在排除术前感染病例后,伴有感染性并发症病例的血PCT值在术后第1、3、7天均高于无并发症病例(t=2.92,P＜0.01;t=5.34,P＜0.01;t =4.03,P＜0.05).血PCT在术后第1、3、7天的受试者工作特征曲线下面积分别为0.89、0.82和0.87,相对应的最佳阈值为0.75、0.84、0.71 ng/ml,其中第1天和第7天的曲线下面积在所有参数中最高.在无并发症组中,术后第1、3、7天的平均血PCT值分别为(0.47 ±0.97)、(0.36±0.50)、(0.23 ±0.24) ng/ml,从术后第1～3天以及术后第3～7天,血PCT值均平均下降55％.结论无术后并发症的患者血PCT值呈明显下降趋势,而有术后感染性并发症患者的血PCT值明显上升,连续监测血PCT值可以更有效地判断术后感染性并发症的发生.
목적 학정위수술후환자혈강개소원(procalcitonin,PCT)치적영향인소,평고이혈PCT치판단위수술후환자발생감염성병발증적작용.방법 종2011년6월지2013년1월,장비련속적153례행위수술적환자납입연구,기록기재수술제1、3、7천적체온、혈PCT、외주혈백세포계수급중성립세포비례,분석영향술후혈PCT치적인소,병분별연구기판단감염성병발증적능력.결과 술후병발증、수술류형화행급진수술대술후제1천적혈PCT치유일정정도적영향,이술후제3천화제7천혈PCT치적영향인소균위술후병발증.재배제술전감염병례후,반유감염성병발증병례적혈PCT치재술후제1、3、7천균고우무병발증병례(t=2.92,P＜0.01;t=5.34,P＜0.01;t =4.03,P＜0.05).혈PCT재술후제1、3、7천적수시자공작특정곡선하면적분별위0.89、0.82화0.87,상대응적최가역치위0.75、0.84、0.71 ng/ml,기중제1천화제7천적곡선하면적재소유삼수중최고.재무병발증조중,술후제1、3、7천적평균혈PCT치분별위(0.47 ±0.97)、(0.36±0.50)、(0.23 ±0.24) ng/ml,종술후제1～3천이급술후제3～7천,혈PCT치균평균하강55％.결론 무술후병발증적환자혈PCT치정명현하강추세,이유술후감염성병발증환자적혈PCT치명현상승,련속감측혈PCT치가이경유효지판단술후감염성병발증적발생.
Objective To analyse the factors that have effects on patients' procalcitonin (PCT)level after gastic surgery and to evaluate PCT as a parameter for detection of infectious complications.Methods A total of 153 patients undergoing gastric surgery were included in the study between Jul 2011 and Jan 2013.Temperature and routine blood samples for determining PCT level,neutrophil ratio,white blood cell count were obtained on postoperative days (POD) 1,3,7.Predictive values for each of the markers were examined.Results Postoperative complication,preoperative infection and surgery type affected the PCT level of patients on POD 1.Meanwhile,the independent factor that had influence on PCT level on POD 3 and 7 was postoperative complication.After excluding those patients with preoperative infection,patients with infectious complication exhibited significantly higher PCT levels (t =2.92,P ＜0.01,t =5.34,P ＜0.01,t =4.03,P ＜0.05) on POD 1,3,7 respectively),neutrophil ratio (on POD 3 and 7) and WBC count (on POD 3) than did those without complication.According to receiver operating characteristic analysis,PCT showed the highest AUC on POD 1,7 (AUC =0.89 and 0.87 respectively).In the patients without complication,the mean PCT value was (0.47 ± 0.97),(0.36 ± 0.50),(0.23 ± 0.24) ng/ml on POD 1,3,7 respectively.The PCT level declined 55％ from POD 1 to POD 3 and from POD 3 to POD 7.Conclusions The serum PCT level of patients without any complication showed a decreasing trend while PCT level of those with infectious complications increased significantly.Continuous monitoring PCT level could serve as a diagnostic tool for the early identification of infectious complication after gastric surgery.