【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。
[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.
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