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目的探讨严重多发伤后血清酶含量及血液炎症因子动态变化及其临床意义。方法对142例多发伤患者分别在伤后第1、3、5、7和14d检测血清CPK、LDH、ALT、AST的含量及血浆PCT、血清TNF-α、IL-6浓度水平变化,分别根据ISS评分和预后情况分组,比较检测结果。结果⑴严重伤组伤后第1dCPK、AST、ALT、LDH均有不同程度上升,均明显高于与轻伤组同期指标(P<0.01或P<0.05);⑵轻伤组患者伤后第3d起血浆PCT浓度测定均无明显升高,严重伤组患者血浆PCT浓度自发病起始终于高水平范围内波动,两组差异有统计学意义(P<0.01或P<0.05);严重伤组TNF-α、IL-6在第3d已开始升高,均明显高于轻伤组同期指标(P<0.01或P<0.05);⑶死亡组血清酶和炎症因子的浓度水平均明显高于存活组(P<0.01)。结论严重多发伤后血清酶含量及炎症因子水平升高显著,在一定程度上能反应体内炎症反应程度,监测严重多发伤患者的血清酶、PCT、TNF-α及IL-6水平有助于判断疾病的发展及顸后。
Objective To investigate the dynamic changes of serum enzyme and blood inflammatory factors after severe multiple trauma and its clinical significance. Methods Serum levels of CPK, LDH, ALT and AST, plasma concentrations of PCT, serum TNF-α and IL-6 in 142 patients with multiple traumatic injury were detected on the 1st, 3rd, 5th, 7th and 14th day after injury respectively. ISS score and prognosis group, compare the test results. Results (1) The levels of CPK, AST, ALT and LDH in severe injury group increased to some extent on the 1st day after injury, which were significantly higher than those in the mild injury group (P <0.01 or P <0.05) Plasma PCT concentration was no significant increase in the plasma concentration of PCT in patients with severe injury since the onset of high levels of fluctuations in the range of the highest level, the difference between the two groups was statistically significant (P <0.01 or P <0.05); severe injury group TNF (P <0.01 or P <0.05) .③The levels of serum enzymes and inflammatory cytokines in death group were significantly higher than those in survival group (P <0.01). Conclusions The levels of serum enzymes and inflammatory cytokines increase significantly after severe multiple trauma. To a certain extent, they can reflect the degree of inflammatory reaction in vivo and monitor the levels of serum enzymes, PCT, TNF-α and IL-6 in patients with severe multiple trauma The development of the disease and afterwards.