Study On Procalcitonin Detection In Early Postoperative Infection After Thoracic Surgery

Postoperative infection of thoracic surgery mostly by the patient during the treatment due to the body's reduced ability to resist bacteria,poor health is caused by microbial invasion a series of pathophysiological changes of the disease.Infectious disease refers to the human body environment by bacteria,fungi and viruses.Now,with the development of medical technology,the popularity of antibiotics and clinically,the heoretical renovation,operative improvement,material development and public health,diagnosis and treatment of infectious diseases have undergone a significant change.Infection after thoracic surgery tends to decline recently.However,infection occurs once,not only extend length of patient stay,Increase the patient's financial burden,but also it even increases the patient's fatality rate and other serious consequences.Therefore,it is essential to improve the diagnosis rate of infectious diseases and pathogen identification.The patient's body has inflammatory reaction after thoracic surgery operation,traditional parameters used for diagnosis of infection,such as white blood count(WBC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),D-dimer and other inflammatory factors are frequently elevated by nonspecific inflammation response without bacterial infection.Microscopy and bacterial culture is an important basis for diagnosis of bacterial infections,but clinical applications,there is often sampled complex,long bacterial culture period,the positive rate and other negative factors.So,a new indicator is urgently needed to distinguish between inflammation and infection,which provides an exact basis for early diagnosis of nosocomial infection after operation.ProcaIcitonin(PCT),as a new diagnostic marker of infection,not only presents positve correlation with the severity of infection,but also reduces the use of antdoiotics under its guidance.Only a few studies have evaluate the use of PCT after thoracic surgery operation,the arms is to study the changes of serum procalcitonin in the preoperative of thoracic surgery and after operation,and understand its normal dynamic change curve,and evaluate the monitoring of postoperative infection after thoracic surgery.Objective:To monitor serum procalcitonin(PCT)levels in the postoperative infection patients and to investigate the early diagnosis value of blood procalcitonin(PCT)in early infection after thoracic surgery.Methods:341 operation patients of thoracic surgery were selected in our hospital from March 2016 to March 2017.Among them,105 patients with postoperative infection were set as the infection group,while 236 patients without infection were set as the non-infection group.65 healthy persons were selected as the control group.All the people underwent serum procalcitonin detection,white blood cell count(WBC),C reactive protein(CRP)detection.Changes of relevant indexes at different time points(preoperative,postoperative,postoperative 1d,postoperative 3d,postoperative 6d)were compared between groups,and,the sensitivity?specificity?positive predictive value and negative predictive value of PCT,WBC and CRP in detection of postoperative infection were calculated.Results:PCT,WBC and CRP values of preoperative in the infection group and in non infection group show no significant difference(P>0.05)compared with the control group,PCT,WBC and CRP levels showed a course with a peak postoperative,and all the parameters presents significant difference between the lth day postoperatively and preoperatively in the infection group and in non infection group(P<0.05).Blood procalcitonin,white blood cell count and C-reactive protein at postoperative increased significantly in non-infection group,reached the highest at postoperative 1d,and started declining.Blood procalcitonin,white blood cell count and C-reactive protein at postoperative increased significantly in the infection group,reached the highest at postoperative 3d,PCT,WBC and CRP values in the infection group were higher than those in non infection group preoperative,on a different occasion after the operations(P<0.05).Serum procalcitonin in patients with moderate infection were higher than those with mild infection,and serum procalcitonin in patients with severe infection were higher than those with moderate infection and mild infection.If PCT?0.5ng/ml,WBC?10*10~9/L,CRP?8mg/L as positive threshold,the sensitivity,specificity,positive predictive value and negative predictive value to diagnosis of postoperative infection,PCT:88.6%,80.9%,67.4%,94.1%,WBC:75.2%,71.2%,53.7%,86.6%,CRP:63.8%,60.6%,41.9%,79.0%.The sensitivity,specificity,positive predictive value and negative predictive value of PCT were better than those of WBC and CRP.Conclusion:Postoperative infection of thoracic surgery is likely to be the cause of the increased PCT,WBC and CRP.The sensitivity,specificity,positive predictive value and negative predictive value of PCT were much better than those of WBC and CRP.Serum procalcitonin can be used as effective indexes in the diagnosis of early infection after thoracic surgery.Monitoring value of serum PCT dynamically can reflect the severity and progress of bacterial infection,and provide objective evidence for clinicians to assess the disease and adjust treatment.