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目的观察老年脓毒性休克患者降钙素原(procalcitonin,PCT)水平动态变化及其在预后和病情评估中的价值。方法对97例老年脓毒症休克患者随访28d,根据预后分为存活组65例和死亡组32例,比较2组入院时急性生理学与慢性健康状况评分系统Ⅱ(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)和序贯器官衰竭评分(Sequential Organ Failure Assessment,SOFA评分),血清C反应蛋白(C-reactive protein,CRP)、PCT水平及入院第3、7天PCT水平,分析PCT与SOFA评分和APACHEⅡ评分的相关性。结果 2组入院时及入院第3天血清PCT水平比较差异均无统计学意义(P>0.05);死亡组入院时乳酸[(6.18±3.52)mmol/L]、SOFA评分(11.26±4.39)分和APACHEⅡ评分[(20.38±5.72)]分明显高于存活组[(4.42±3.47)mmol/L、(6.87±3.54)分、(17.65±4.79)分](P<0.05);死亡组入院时血清CRP水平[(64.7±35.2)mg/L]与存活组[(58.2±23.5)mg/L]比较差异无统计学意义(P>0.05);死亡组入院第7天PCT水平[(10.82±3.58)μg/L]明显高于存活组[(1.25±0.73)μg/L](P<0.01),与入院时[(9.98±3.42)μg/L]比较差异无统计学意义(P>0.05);存活组入院第7天PCT水平较入院时[(10.12±4.56)μg/L]明显下降(P<0.05);入院第7天脓毒性休克患者PCT水平与SOFA评分和APACHEⅡ评分呈正相关(r=0.625,P=0.001;r=0.646,P=0.002);PCT预测死亡的AUC为0.831,PCT为2.0μg/L时对死亡预测的敏感度为82.4%,特异度为71.6%。结论 PCT可评估老年脓毒性休克患者预后,PCT持续保持高水平提示预后不佳。
Objective To investigate the dynamic changes of procalcitonin (PCT) level and its prognosis and prognosis in septic shock patients. Methods A total of 97 elderly patients with septic shock were followed up for 28 days. According to the prognosis, they were divided into survival group (65 cases) and death group (32 cases). Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) ), Sequential Organ Failure Assessment (SOFA) score, serum C-reactive protein (CRP) level, PCT level and the PCT level on the 3rd and 7th day after admission. The PCT, SOFA and APACHEⅡ scores Relevance. Results There were no significant differences in serum PCT levels between the two groups on admission and on the third day after admission (P> 0.05). Lactic acid [(6.18 ± 3.52) mmol / L] and SOFA (11.26 ± 4.39) And APACHEⅡscore [(20.38 ± 5.72)] were significantly higher than those in survivals [(4.42 ± 3.47) mmol / L, (6.87 ± 3.54) vs (17.65 ± 4.79) There was no significant difference in CRP level between the death group and the survival group [(64.2 ± 35.2) mg / L [(58.2 ± 23.5) mg / L] 3.58) μg / L] was significantly higher than that in the survival group [(1.25 ± 0.73) μg / L] (P <0.01), but no significant difference compared with that of the admission group [(9.98 ± 3.42) μg / L] ). The PCT level in the surviving group on the 7th day after admission was significantly lower than that on admission ([10.12 ± 4.56] μg / L] (P <0.05). The PCT level on the 7th day after admission was positively correlated with SOFA and APACHEⅡ r = 0.625, P = 0.001; r = 0.646, P = 0.002). The AUC of PCT predicted death was 0.831, the sensitivity of death prediction was 82.4% and the specificity was 71.6% when PCT was 2.0μg / L. Conclusions The PCT can assess the prognosis of elderly patients with septic shock. A sustained high PCT level suggests a poor prognosis.