降钙素原监测对上尿路结石术后感染性休克早期诊治的价值

外科研究与新技术 ›› 2015, Vol. 4 ›› Issue (3): 145-148.

降钙素原监测对上尿路结石术后感染性休克早期诊治的价值

相俊

上海市同济医院

收稿日期:2015-07-21 修回日期:2015-08-23 出版日期:2015-09-28 发布日期:2015-10-08
通讯作者: 相俊 E-mail:wallyxiang@126.com

The value of procalcitonin monitoring in early diagnosis and therapy of postoperative septic shock of upper urinary tract stones surgery

Received:2015-07-21 Revised:2015-08-23 Online:2015-09-28 Published:2015-10-08

摘要/Abstract

摘要： 【摘要】目的探讨降钙素原监测在上尿路结石内镜治疗并发感染性休克患者早期诊断及预后判断中的价值，以指导治疗。方法对2012年6月～2013年12月我院1027例上尿路结石行经皮肾镜及输尿管镜碎石术病例进行前瞻性研究，分析发生感染性休克患者的临床资料，检测术后4h、48h患者降钙素原、血常规、血生化等指标。以术后4h降钙素原≥10ng/ml为感染性休克阈值，早期选用三代头孢菌素或碳青霉烯类抗菌药物，同时积极采取抗休克综合治疗。当降钙素原持续回落至＜2ng/ml，48h后根据细菌培养结果降级使用抗生素，并对术后48h降钙素原数值较高者加强支持治疗。结果发生感染性休克7例，术后4h降钙素原≥10ng/ml者12例，其中感染性休克6例，降钙素原诊断敏感性85.7%，特异性99.4%，均优于C反应蛋白与白细胞。术后4h降钙素原27.8±18.4ng/ml，48h降钙素原42.2±29.7ng/ml，差异具有统计学意义（P＜0.05）。术后8.4±4.2d降钙素原下降至＜2ng/ml，按上述原则积极治疗后，所有患者均好转出院。48h降钙素原数值高者抗生素用药强度及住院时间大于其余患者。结论降钙素原监测对上尿路结石治疗中感染性休克早期诊断及预后判断具有重要价值，根据降钙素原数值早期积极治疗并调整用药，有利于疾病转归。

关键词: 降钙素原, 上尿路结石, 感染性休克

Abstract: [Abstract] Objective To explore the value of procalcitonin monitoring in the early diagnosis and prognosis of postoperative septic shock of upper urinary tract stones endoscopic surgery. Methods From Jun 2012 to Dec 2013, 1027 patients undergoing minimally invasive percutaneous nephrolithotomy lithotomy or ureterscopy lithotripsy were prospective studied, the clinical data of patients with postoperative septic shock were analyzed. Procalcitonin, routine blood and blood biochemical indexes were detected at postoperative 4 h and 8 h. Useing PCT≥10ng/ml at 4 h after surgery as a threshold. Choosing the third generation cephalosporins or carbapenems at the early stage and taking active anti-shock treatmen. According to the results of bacterial culture, useing low-level antibiotics when PCT continues to decrease to < 2 ng/m at postoperative 48h, also, to strengthen support for treatment in patients with higher PCT level. Results Septic shock occurred in 7 cases, and 6 cases of septic shock in 12 patients whose PCT≥10ng/ml at postoperative 4h, PCT has a higher diagnostic sensitivity (85.7%) and specificity (99.4%) than c-reactive protein and white blood cells. PCT 27.8±18.4 ng/ml at postoperative 4 h and PCT 42.2±29.7 ng/ml at postoperative 48h, the difference is statistically significant（P＜0.05）. All cases were improved and discharged after active treatment according to the above principles when PCT decrease to ＜2 ng/ml on postoperative 8.4±4.2 d. The antibiotics use density and hospital stay of patients with higher PCT are stronger and longer than other patients. Conclution The monitoring of PCT has significant value in the early diagnosis and prognosis of postoperative septic shock of upper urinary tract stones surgery. Actively treating in earlier period and adjusting the dosage according to PCT level is beneficial to the outcome of septicshock.

Key words: procalcitonin, upper urinary tract stones, septic shock

相俊. 降钙素原监测对上尿路结石术后感染性休克早期诊治的价值[J]. 外科研究与新技术, 2015, 4(3): 145-148.

参考文献

参考文献
[1] Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med, 2013,39(2):165-228.
[2] Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol, 2007,51(4):899-906; discussion 906.
[3] Vorrakitpokatorn P, Permtongchuchai K, Raksamani EO, et al. Perioperative complications and risk factors of percutaneous nephrolithotomy. J Med Assoc Thai, 2006,89(6):826-833.
[4] Mariappan P, Smith G, Bariol SV, et al. Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol, 2005,173(5):1610-1614.
[5] Li K, Liu C, Zhang X, et al. Risk factors for septic shock after mini-percutaneous nephrolithotripsy with holmium laser. Urology, 2013,81(6):1173-1176.
[6] 那彦群, 孙颖浩. 中国泌尿外科疾病诊断治疗指南. 北京:人民卫生出版社,2014.428-429.
[7] Wacker C, Prkno A, Brunkhorst FM, et al. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis, 2013,13(5):426-435.
[8] Brunkhorst FM, Wegscheider K, Forycki ZF, et al. Procalcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis, and septic shock. Intensive Care Med, 2000,26 Suppl 2:S148-152.
[9] Reinhart K, Meisner M, Brunkhorst FM. Markers for sepsis diagnosis: what is useful. Crit Care Clin, 2006,22(3):503-519, ix-x.
[10] 邓刚, 马立彬, 居翔, 等. 血清降钙素原在上尿路腔内碎石术后脓毒血症诊治中的应用研究. 中华医院感染学杂志, 2013,23(24):5924-5926.
[11] Zheng J, Li Q, Fu W, et al. Procalcitonin as an early diagnostic and monitoring tool in urosepsis following percutaneous nephrolithotomy. Urolithiasis, 2014.
[12] Hatherill M, Tibby SM, Sykes K, et al. Diagnostic markers of infection: comparison of procalcitonin with C reactive protein and leucocyte count. Arch Dis Child, 1999,81(5):417-421.
[13] Fioretto JR, Martin JG, Kurokawa CS, et al. Comparison between procalcitonin and C-reactive protein for early diagnosis of children with sepsis or septic shock. Inflamm Res, 2010,59(8):581-586.
[14] Sugimoto K, Shimizu N, Matsumura N, et al. Procalcitonin as a useful marker to decide upon intervention for urinary tract infection. Infect Drug Resist, 2013,6:83-86.
[15] O'Keeffe NK, Mortimer AJ, Sambrook PA, et al. Severe sepsis following percutaneous or endoscopic procedures for urinary tract stones. Br J Urol, 1993,72(3):277-283.
[16] Korets R, Graversen JA, Kates M, et al. Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol, 2011,186(5):1899-1903.
[17] 姚剑, 顾金华. 上尿路结石的细菌学研究及其临床意义. 中华泌尿外科杂志, 2005,26(8):542-544.
[18] Prkno A, Wacker C, Brunkhorst FM, et al. Procalcitonin-guided therapy in intensive care unit patients with severe sepsis and septic shock--a systematic review and meta-analysis. Crit Care, 2013,17(6):R291.
[19] Xu RY, Liu HW, Liu JL, et al. Procalcitonin and C-reactive protein in urinary tract infection diagnosis. BMC Urol, 2014,14:45.
[20] Bouadma L, Luyt CE, Tubach F, et al. Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet, 2010,375(9713):463-474.