Clinical utility or peri-operative C-reactive protein testing in general surgery
Clinical utility or peri-operative C-reactive protein testing in general surgery
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DOI：
10.1308/003588408x285865
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发表时间：
2008-05-01
影响因子：
1.4
通讯作者：
Avades, Tony
中科院分区：
文献类型：
--
作者：
Cole, Duncan S.;Watts, Andrew;Avades, Tony
简介 C 反应蛋白 (CRP) 是一种急性时相蛋白，临床上用于诊断感染性和炎症性疾病并监测治疗反应。对择期普外科患者围手术期的 CRP 测量进行审核，并分析其变化模式。患者和方法 本研究考虑了 3 个月期间入院接受择期普外科手术的普外科患者 (201)。记录术前和术后的 CRP 结果，并记录共病情况和手术过程的数据。结果 84% 的患者在术前要求进行 CRP。有合并症的患者更有可能出现高 CRP。术后前 3 天，69% 的患者需要进行 CRP。 CRP 在术后两三天达到峰值，然后下降。在术前CRP较高的患者中，与术前CRP正常的患者相比，CRP峰值较高且出现较晚。 结论 术前要求CRP的情况很常见，但NICE指南不建议这样做。术后，CRP 水平升高；因此，其作为感染筛查工具的用途受到限制。 CRP 在术后前三天后的感染诊断和监测治疗反应中发挥作用。因此，不建议在术前和术后 2 或 3 天内常规使用 CRP 测量。仅当有明确的临床指征时才应要求进行围手术期 CRP。
INTRODUCTION C-reactive protein (CRP) is an acute-phase protein used clinically to diagnose infectious and inflammatory disease and monitor response to treatment. CRP measurement in the peri-operative period was audited and patterns of change analysed for elective general surgical patients.PATIENTS AND METHODS General surgical patients (201) admitted for elective general surgery over a 3-month period were considered for the study. CRP results pre- and postoperatively were recorded, and data on co-morbid conditions and surgical procedure were noted.RESULTS CRP was requested pre-operatively on 84% of patients. A high CRP was more likely to be found in patients with co-morbidity. Postoperatively, CRP was requested during the first 3 days on 69% of patients. CRP peaked at postoperative days two or three, and then fell. In patients who had a high pre-operative CRP, the peak CRP was higher and occurred later, than those who had a normal pre-operative CRP.CONCLUSIONS CRP requesting pre-operatively is common, but is not recommended in NICE guidelines. Postoperatively, CRP levels rise; as a result, its use as a tool to screen for infection is limited. CRP has a role in diagnosis of infection after the first three postoperative days and in monitoring response to treatment. Therefore, routine use of CRP measurements pre-operatively and in the first 2 or 3 days post-operatively is not recommended. A peri-operative CRP should only be requested if there is a clear clinical indication.