骨盆髋臼骨折患者围手术期炎症指标的变化及意义

摘要

目的：探讨骨盆髋臼骨折患者围手术期白细胞介素－6（IL－6）、C 反应蛋白（CRP）、降钙素原（PCT）的变化及临床意义。方法笔者选取2014年1月～2014年12月收治的骨盆髋臼骨折手术患者18例，依据有无感染性并发症分为正常组14例（N 组）及并发症组 4例（C 组），分别测定术前1d，术后即时，术后1、2、4、7d 的 IL－6、CRP、PCT 以及体温、心率、呼吸、白细胞计数（WBC）。结果（1） N 组患者围手术期体温、呼吸、心率及白细胞计数均无统计学差异，C 组患者围手术期体温、呼吸、心率变化不明显，WBC 计数呈逐渐上升趋势。（2） N 组患者 IL－6水平术后即出现升高（较术前 P ＜0．05），术后1d 时 IL－6水平升高最为明显（P ＜0．01）； CRP 水平术后即时与术前水平无显著差异，术后1d 时 CRP 水平高于术前（P ＜0．05），在术后2d 时 CRP 水平升高最为明显（P ＜0．01）； PCT 水平在术后均与术前水平无显著差异。 C 组2例患者术后早期 IL－6、CRP、PCT 水平变化趋势与 N 组相似，但三者均在术后7d 再次出现显著升高。结论围手术期监测患者 IL－6、CRP、PCT 水平变化，有助于评估患者术后机体炎症反应状态、判断有无术后感染风险。%Objective To investigate variations and clinical significance of interleukin-6(IL-6),C-reactive protein(CRP), procalcitonin(PCT)in patients with pelvic acetabulum fractures during perioperative period.Meth-ods From Jan.2014 to Dec.2014,eighteen patients with pelvic acetabulum fractures were divided into the normal group(n =14)and the complication group(n =4).The levels of IL-6,CRP,PCT in blood were detected 1 day be-fore operation, immediately after operation,and 1,2,4,7 days after operation.Respiratory rate,heart rate,tempera-ture and white blood cells(WBC)were also detected.Results (1) No significant difference of respiratory rate, heart rate,temperature and WBC count was found in patients of the normal group during perioperative period.The variations of respiratory rate,heart rate,temperature were stable in the complication group,however,the WBC count of patients in the complication group showed a rise trend after the operation.(2)The postoperative level of IL-6 in patients of the normal group were remarkably increased compared with preoperative level(P <0.05),and was signif-icantly higher 1day after operation(P <0.01).While the CRP level in the normal group gradually rised after opera-tion,and was significantly higher 2 days after operation(P <0.01).The level of PCT in the normal group was stable during the perioperative period.The variation trends of IL-6,CRP and PCT levels in the complication group were the same as those in the normal group at early postoperative period, while were significantly elevated 7 days after op-eration.Conclusion Monitoring of the variations of IL-6,CRP,PCT during the perioperative period may help to e-valuate inflammatory reaction status and the risk of postoperative infection.