發(fā)布時間：2018-06-21 20:40

  本文選題：經皮腎鏡碎石術 + 尿膿毒血癥��； 參考：《青島大學》2014年碩士論文

【摘要】：目的：探討通過監(jiān)測血漿降鈣素原(procalcitonin, PCT)水平對于早期診斷繼發(fā)于經皮腎鏡碎石術(percutaneous nephrolithotomy, PCNL)的尿膿毒血癥的臨床意義。 方法：回顧性分析青島大學附屬醫(yī)院泌尿外科住院部2012年1月至2013年11月收治的復雜上尿路結石并行PCNL手術患者共98例,按照2013年歐洲泌尿外科學會指南(EAU Guidelines)對尿膿毒血癥的診斷標準分為觀察組(PCNL術后繼發(fā)尿膿毒血癥)48例和對照組(PCNL術后未出現尿膿毒血癥)50例,回顧性分析兩組患者術前、術后6h內、術后24h所檢測的血漿PCT和C-反應蛋白(c-reactive protein, CRP)水平,計算兩組數據均數、標準差,組內數據統(tǒng)計分析采用配對t檢驗,P0.05為差異具有統(tǒng)計學意義；組間數據統(tǒng)計分析采用成組t檢驗,P0.05為差異具有統(tǒng)計學意義；評價PCT和CRP對尿膿毒血癥的診斷效能采用受試者工作特征曲線(ROC曲線),計算ROC曲線下面積(AUC),對AUC比較采用Z檢驗,P0.05為差異具有統(tǒng)計學意義,并分析PCT和CRP對尿膿毒血癥的診斷敏感度、特異度以及最佳截斷點(臨界值)。 結果：兩組患者術前PCT、CRP水平均在正常范圍,組內、組間比較均無統(tǒng)計學意義(P0.05)；觀察組48例患者均于術后6h內出現尿膿毒血癥,對觀察組和對照組患者的PCT、CRP水平進行組內比較,發(fā)現其均較術前升高(P0.05),進行組間比較,發(fā)現觀察組PCT水平較對照組明顯升高(P0.01),而觀察組CRP亦較對照組升高(P0.05),但對兩項診斷指標PCT和CRP的診斷效能進行ROC曲線分析,結果顯示PCT的AUC較CRP的AUC大,差異比較具有統(tǒng)計學意義(P0.05)。 結論：PCNL術后疑似繼發(fā)尿膿毒血癥時,測定血PCT水平有助于對尿膿毒血癥的早期臨床診斷,PCT對尿膿毒血癥的診斷效能較CRP更高。
[Abstract]:Objective: to investigate the clinical significance of monitoring plasma procalcitonin (PCT) level in early diagnosis of urinary sepsis secondary to percutaneous nephrolithotripsy (PCNL). Methods: a retrospective analysis of 98 patients with complicated upper urinary calculi treated by PCNL from January 2012 to November 2013 was performed in the Department of Urology, affiliated Hospital of Qingdao University. According to the guidelines of the European Society of Urology (2013), Eau Guidelines-based criteria for the diagnosis of urinary sepsis were divided into observation group (n = 48) and control group (n = 50). The levels of plasma PCT and C-reactive protein (CRP) were measured within 6 hours and 24 hours after operation. The mean and standard deviation of the two groups were calculated. The statistical analysis of the data in the group was statistically significant by pairing t test (P0.05). There was statistical significance in statistical analysis of data between groups by using group t test (P0.05). To evaluate the effectiveness of PCT and CRP in the diagnosis of urinary sepsis the ROC curve was used to calculate the area under the ROC curve and the area under the ROC curve was calculated. There was significant difference in AUC using Z test (P0.05). The sensitivity, specificity and optimal cut-off point of PCT and CRP in the diagnosis of urinary sepsis were analyzed. Results: the preoperative levels of PCTnCRP in both groups were in the normal range, and there was no significant difference between the two groups, while in the observation group, the urinary sepsis was found in 48 patients within 6 hours after operation, and the levels of PCTnc-CRP in the observation group and the control group were compared. It was found that the level of PCT in the observation group was significantly higher than that in the control group, and the CRP in the observation group was also higher than that in the control group. However, the diagnostic efficacy of two diagnostic indexes, PCT and CRP, was analyzed by ROC curve analysis. The results showed that the AUC of PCT was larger than that of CRP, and the difference was statistically significant (P 0.05). Conclusion determination of blood PCT level is helpful to the early clinical diagnosis of urinary sepsis in patients with suspected secondary sepsis after urine PCNL. PCT is more effective than CRP in the diagnosis of urinary sepsis.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R699.2

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本文編號：2049940