血清降钙素原在神经外科ICU抗菌药物管理中的应用  

Utility of serum procalcitonin in antibiotic management in neurosurgical intensive care unit

作　　者：卢天舒[1] 关靖宇[1] 

机构地区：[1]沈阳军区总医院,辽宁沈阳110840

出　　处：《中国微生态学杂志》2013年第3期315-316,320,共3页Chinese Journal of Microecology

摘　　要：目的分析PCT(PCT)在神经外科ICU中抗菌药物管理中的作用。方法回顾分析2011年5月至2012年5月沈阳军区总医院神经外科ICU中67例常规经验性判断无法明确是否存在细菌感染而应用PCT指导抗菌药物管理的病例。PCT截断点为0.25 ng/mL。结果 47例PCT检测应用在抗菌药初始应用阶段,男27例,女20例。高血压脑出血20例,闭合性颅脑损伤10例,自发蛛网膜下腔出血17例。40例PCT检测低于判断标准病例未使用抗菌药。20例PCT检测应用在抗菌药停用阶段,男12例,女8例。高血压脑出血10例,颅脑损伤5例,颅内动脉瘤5例。15例PCT检测低于标准停用抗菌药。55例PCT指导未使用抗菌药及停用抗菌药病例观察1周,均无感染相关并发症发生。结论 PCT在神经外科ICU中可以有效指导部分病例的抗菌药物管理,较经验性用药可更为有效地减少抗菌药的用量。Objective To evaluate the utility of serum procalcitonin （PCT） measurement as an additional diagnostic tool to sup- port antibiotic management in neurosurgical intensive care unit. Methods Sixty-seven cases in the neurosurgical ICU from 2011 to 2012 for who there was a clinical suspicion of infection but the diagnosis was uncertain were analyzed. The antibiotic decision of these cases were supported by serum PCT measurement. The cut-off concentration of PCT levels （mg/L） used was 0.25. Results The serum PCT measurement was utilited in the initiating stage of antibiotics in 47 cases, including 20 in hypertensive cerebral hemorrhage patients, 10 in closed craniocerebral injury, and 17 in subarachnoid bleeding. On the basis of low PCT values, antibiotic treatment was not commenced on 40 cases. The serum PCT measurement was utilited in the withholding stage of antibiotics in 20 cases, including 10 in hypertensive cerebral hemorrhage patients, 5 in ocraniocerebral injury, and 5 in cerebral aneurysm. On the basis of low PCT values, antibiotics were withheld in 15 cases. Conclusion PCT has the potential to become a valuable tool in antibiotic management in neurosurgical ICU. It is more helpful to reduce unnecessary antibiotic usage than empirical antibiotics management.

关 键 词：神经外科 PCT 抗生素 

分 类 号：R181.3[医药卫生—流行病学]