Szakmány Tamás, Márton Sándor, Molnár Zsolt
Anaesthesiológiai és Intenzív Terápiás Intézet, Pécsi Tudományegyetem, Altalános Orvostudományi Kar, 7643 Pécs, Ifjúság u. 13.
Magy Seb. 2002 Feb;55(1):16-23.
Predicting outcome in critical care remains difficult. One factor making the task difficult is, that the time elapsed between the onset of symptoms and admission to the intensive care unit is often unknown. The aim of this study is to evaluate the early course and predictive value of organ dysfunction monitored by Multiple Organ Dysfunction Score (MODS) and serum procalcitonin (PCT), microalbuminuria (M:Cr) following oesophageal tumor resection.
In our prospective study, 79 patients (67 survivors, 12 non-survivors) are involved all had elective oesophageal tumour resection. MODS was monitored daily (t1, t2, t3). Serum PCT levels were determined 24 hourly (t0, t24, t48, t72). M:Cr was measured before (tp), and after surgery (t0, t6, t24, t48, t72). For statistical analysis Wilcoxon rank sum test, Mann-Whitney U test, receiver operating characteristic curve analysis and logistic regression analysis were used.
Significantly higher MODS were observed in patients who died. As of organ dysfunction, PaO2/FiO2 ratio was below normal and remained significantly lower in non-survivors at t1, t2, t3. Serum PCT at t0 was normal in both groups. Levels at t24 increased significantly, and values were significantly higher in non-survivors. Levels remained elevated at t48 and t72 without statistically significant difference between the two groups. Preoperative M:Cr was normal. At t0 levels increased significantly, but then at t6-72 levels returned to normal without significant differences between survivors and non-survivors.
The PaO2/FiO2 ratio gave clear differentiation between survivors and non-survivors. It seems to be a sensitive measurement for predicting outcome following oesophagectomy. Routine measurement of serum PCT in the postoperative period may help predicting outcome but further studies are required.
预测重症监护的结果仍然很困难。使这项任务变得困难的一个因素是，症状出现到入住重症监护病房之间经过的时间往往未知。本研究的目的是评估食管肿瘤切除术后通过多器官功能障碍评分（MODS）、血清降钙素原（PCT）和微量白蛋白尿（M:Cr）监测的器官功能障碍的早期病程及预测价值。
在我们的前瞻性研究中，纳入了79例行择期食管肿瘤切除术的患者（67例存活者，12例非存活者）。每天监测MODS（t1、t2、t3）。每24小时测定一次血清PCT水平（t0、t24、t48、t72）。术前（tp）及术后（t0、t6、t24、t48、t72）测量M:Cr。统计分析采用Wilcoxon秩和检验、Mann-Whitney U检验、受试者工作特征曲线分析和逻辑回归分析。
死亡患者的MODS明显更高。就器官功能障碍而言，PaO2/FiO2比值低于正常水平，且在t1、t2、t3时非存活者显著更低。两组患者t0时血清PCT均正常。t24时水平显著升高，且非存活者的值显著更高。t48和t72时水平仍升高，两组间无统计学显著差异。术前M:Cr正常。t0时水平显著升高，但随后在t6 - 72时水平恢复正常，存活者与非存活者之间无显著差异。
PaO2/FiO2比值在存活者和非存活者之间有明显区分。它似乎是预测食管切除术后结果的一个敏感指标。术后常规测定血清PCT可能有助于预测结果，但还需要进一步研究。
