C-反应蛋白测定与B超检查对术后腹腔感染诊断的价值
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摘要
目的分析C-反应蛋白(CRP)结合B超检查对外科手术后腹腔感染的诊断价值。方法选择医院行腹腔镜手术的患者146例,所有患者均于术前完善相关检查,分别于术后6h、12h、24h、36h、72h取静脉血检测CRP,并严密观察患者感染相关临床症状及体征,若患者出现疑似感染则行腹部B超检查,计算CRP阳性和B超检查阳性患者,判断腹腔感染的灵敏度、特异度和准确度。比较感染组和非感染组患者不同时间段CRP水平。对感染病原菌进行培养与鉴定。结果 146例患者术后病原学阳性18例,感染率12.33%。18例感染患者共检出病原菌28株,其中革兰阴性菌15株占53.57%,革兰阳性菌11株占39.29%,真菌2株占7.14%。术后12h、24h、36h、72h感染组患者CRP水平高于非感染组(P<0.05)。术后12h患者CRP指标水平联合B超筛查术后腹腔感染的灵敏度为72.22%,特异度为97.66%,准确度为94.52%。结论腹腔镜术后患者医院感染率较高,术后12hCRP指标水平联合B超筛查腹腔感染特异度和准确度较高,具有较高的临床价值。
OBJECTIVE To analyze the value of C-reactive protein(CRP)combined with B ultrasonography in diagnosis of postoperative abdominal infection.METHODS A total of 146 patients who received laparoscopic surgery in the hospital were enrolled in the study,all of the enrolled patients underwent the related examinations before the surgery,the venous blood specimens were collected after the surgery for 6,12,24,36 and 72 hours so as to detect the CRP,the infection-related clinical symptoms and signs were closely monitored,the patients who had suspected infection received the B ultrasonography,the patients who were positive for CRP and B ultrasonography were calculated.The sensitivity,specificity and accuracy in the diagnosis of abdominal infection were determined,the CRP levels were compared between the infection group and the non-infection group in different time periods,and the pathogens were isolated and identified.RESULTS Of the 146 patients,18 were etiologically positive after the surgery,with the infection rate 12.33%.Totally 28 strains of pathogens were isolated form the 18 patients with infection,15(53.57%)of which were gram-negative bacteria,11(39.29%)were gram-positive bacteria,and 2(7.14%)were fungi.The CRP levels of the infection group were significantly higher than those of the non-infection group after the surgery for 12,24,36 and 72 hours(P<0.05).The sensitivity of the CRP combined with B ultrasonography was 72.22%in screening of the abdominal infection after the surgery for 12 hours,the specificity97.66%,the accuracy 94.52%.CONCLUSION The incidence of postoperative nosocomial infection is high in the patients undergoing the laparoscopic surgery.The accuracy and specificity of the CRP combined with B ultrasonography are high in the screening of the abdominal infection after the surgery for 12 hours,and it has high clinical value.
OBJECTIVE To analyze the value of C-reactive protein(CRP)combined with B ultrasonography in diagnosis of postoperative abdominal infection.METHODS A total of 146 patients who received laparoscopic surgery in the hospital were enrolled in the study,all of the enrolled patients underwent the related examinations before the surgery,the venous blood specimens were collected after the surgery for 6,12,24,36 and 72 hours so as to detect the CRP,the infection-related clinical symptoms and signs were closely monitored,the patients who had suspected infection received the B ultrasonography,the patients who were positive for CRP and B ultrasonography were calculated.The sensitivity,specificity and accuracy in the diagnosis of abdominal infection were determined,the CRP levels were compared between the infection group and the non-infection group in different time periods,and the pathogens were isolated and identified.RESULTS Of the 146 patients,18 were etiologically positive after the surgery,with the infection rate 12.33%.Totally 28 strains of pathogens were isolated form the 18 patients with infection,15(53.57%)of which were gram-negative bacteria,11(39.29%)were gram-positive bacteria,and 2(7.14%)were fungi.The CRP levels of the infection group were significantly higher than those of the non-infection group after the surgery for 12,24,36 and 72 hours(P<0.05).The sensitivity of the CRP combined with B ultrasonography was 72.22%in screening of the abdominal infection after the surgery for 12 hours,the specificity97.66%,the accuracy 94.52%.CONCLUSION The incidence of postoperative nosocomial infection is high in the patients undergoing the laparoscopic surgery.The accuracy and specificity of the CRP combined with B ultrasonography are high in the screening of the abdominal infection after the surgery for 12 hours,and it has high clinical value.
引文
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[12]吴宗劲,华海湖.血清降钙素水平检测在腹腔感染诊治中的应用价值[J].内科,2014,9(3):281-282,316.
[2]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[3]崔潇龙,黄河,郭云童,等.C反应蛋白在结直肠癌术后吻合口瘘早期预测的临床价值[J].中国药物与临床,2016,16(9):1356-1358.
[4] Solomkin JS,Mazuski JE,Bradley JS,et al.Diagnosis and management of complicated intra-abdominal infection in adults and children:guidelines by the Surgical Infection Society and the Infectious Diseases Society of America[J].Surg Infect(Larchmt),2010,11(1):79-109.
[5] Shirah GR,O′Neill PJ.Intra-abdominal Infections[J].Surg Clin North Am,2014,94(6):1319-33.
[6]林洁,曾繁林,刘欣,等.降钙素原测定在腹腔感染疾病中的应用[J].当代医学,2017,23(16):8-10.
[7] Suarez-de-la-Rica A,Maseda E,Anillo V,et al.Biomarkers(procalcitonin,C-reactive protein,and lactate)as predictors of mortality in surgical patients with complicated intra-abdominal infection[J].Surg Infect(Larchmt),2015,16(3):346-351.
[8]王建柏,高劲谋,胡平,等.腹部创伤后严重腹腔感染37例的诊治分析[J].创伤外科杂志,2014,24(3):212-214.
[9] Garcia-Sanchez JE,Garcia-Garcia MI,Garcia-Garrote F,et al.Microbiological diagnosis of intra-abdominal infections[J].Enferm Infecc Microbiol Clin,2013,31(4):230-239.
[10]刘玉元,朱丙烟,付风魁,等.消化道穿孔患者腹腔感染CT的诊断价值分析[J].中华医院感染学杂志,2015,23(13):3042-3044.
[11]鲁建国,张波.胃肠道疾病术后腹腔感染的诊治进展[J].临床外科杂志,2015,23(10):742-743.
[12]吴宗劲,华海湖.血清降钙素水平检测在腹腔感染诊治中的应用价值[J].内科,2014,9(3):281-282,316.