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[用于确定术后感染性并发症的特定指标评估]

[Assessment of specific indicators for determining postoperative infectious complications].

作者信息

Abri O, Pöschel F, Löhde E, Effenberger T, Arndt R, Kraas E

机构信息

I. Chirurgischen Abteilung, Krankenhauses Moabit, Berlin.

出版信息

Zentralbl Chir. 1988;113(21):1393-405.

PMID:2463722
Abstract

The acute-phase proteins CRP, haptoglobin, and sialic acid of 312 surgical patients (159 females and 153 males), aged between 18 and 95 years, were examined with a view to finding parameters for early prediction of perioperative septic complications. Laboratory tests were additionally applied to 39 patients for activated lymphocytes as well as for OKT3-, OKT4-, and OKT8-labelled T-lymphocytes. Straight forward postoperative decline in absolute numbers of OKT3- and OKT4-labelled T-lymphocytes was recordable from patients with septic complications, in contrast to patients with uneventful clinical courses. However, the OKT4 and OKT8 ratio did not yield any correlation with the clinical course. In acute-phase protein testing, a correlation was found to exist between CRP and clinical course. CRP levels in patients without septic complications (Group I) were found to depend clearly on the anatomic site of surgery. Normalisation of CRP levels was recordable from patients with primary septic disease and complete surgical management of the focus (Group II/1). Postoperative decline of CRP values was much less in patients with primary septic disease and incomplete surgical treatment (Group II/2). They had not even reached normality towards the end of observation. On average, unambiguously increased values were recordable as early as three days prior to clinical manifestation from patients with postoperative septic complications (Group III). Septic complications were found to occur along with re-increase or delayed decrease of CRP levels, after the fourth postoperative day. Sensitivity amounted to 78 per cent and specificity to 89 per cent.

摘要

对312名年龄在18至95岁之间的外科手术患者(159名女性和153名男性)的急性期蛋白CRP、触珠蛋白和唾液酸进行了检测,以期找到围手术期感染并发症早期预测的参数。另外对39名患者进行了实验室检测,检测活化淋巴细胞以及OKT3、OKT4和OKT8标记的T淋巴细胞。与临床过程平稳的患者相比,感染并发症患者术后OKT3和OKT4标记的T淋巴细胞绝对数量可记录到明显下降。然而,OKT4与OKT8的比值与临床过程没有相关性。在急性期蛋白检测中,发现CRP与临床过程之间存在相关性。发现无感染并发症患者(第一组)的CRP水平明显取决于手术的解剖部位。原发性感染疾病且病灶得到彻底手术处理的患者(第二组/1)CRP水平可恢复正常。原发性感染疾病且手术治疗不彻底的患者(第二组/2)术后CRP值下降幅度小得多。直至观察结束时他们的CRP水平甚至都未恢复正常。平均而言,术后感染并发症患者(第三组)早在临床表现出现前三天就可记录到明确升高的值。术后第四天之后,发现感染并发症与CRP水平再次升高或延迟下降同时出现。敏感性为78%,特异性为89%。

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