综合ICU降钙素原指导感染患者抗生素治疗的成本效果分析  

Cost - effectiveness analysis of procaicitonin guidance to antibiotic treatment in infected patients of ICU

作　　者：罗华[1] 蔡文训[1] 张卫星[1] 张声[1] 林影芯[1] 

机构地区：[1]北京大学深圳医院ICU,广东深圳518036

出　　处：《中国急救医学》2013年第7期622-626,共5页Chinese Journal of Critical Care Medicine

基　　金：2010年深圳市科技计划基金资助项目（201003081）

摘　　要：目的 通过成本-效果分析的卫生经济学方法,对比常规指导法和降钙素原（PCT）指导法对抗感染的疗效,评价PCT在ICU的监测指导地位.方法 133例感染者按不同抗生素指导方法分为常规法指导治疗组（73例）和PCT指导治疗组（60例）,以SPSS13.0版软件建立数据库,进行两组抗感染治疗的直接医疗成本-效果评价,观察PCT指导抗感染治疗能否减少医疗成本、降低不良反应和改善预后.结果 人均抗感染总成本,人均每日抗生素使用费用,病原学监测次数,继发真菌发生率,耐药菌发生率,副反应总发生率,治疗好转率,治疗恶化率两组比较差异无统计学意义（P〉0.05）,指导抗菌启动时间和监测有效率两组比较差异有统计学意义（P〈0.05）.结论 PCT对指导抗生素起始治疗具有绝对优势,但由于其存在监测费用高、缺少个性化监测指导方案等影响因素,没有明显表现出减少ICU抗生素费用、不良反应和疾病恶化率等优势,现阶段效果成本比低下,无法完全取代传统经验和脱离病原学监测去独立指导抗生素治疗.Objective To compare procalcitonin （PCT） guidance with conventional guidance against the infection in ICU by the cost - effectiveness analysis in order to evaluate the monitoring and guidance of PCT. Methods 133 infected cases were divided into the conventional guidance group （73 cases） and the PCT - guidance group （60 cases）. The direct medical costs - effectiveness analysis in the anti - infection was performed between the groups. To observe whether the PCT - guidance could reduce health care costs, adverse reactions and improve the prognosis. Results There were no statistical differences in total cost of anti -infection in everyone, daily antibiotics fee in everyone, the frequency of pathogen monitoring, antibiotic treatment types of antibiotics, fungal incidence, drug - resistant incidence, the overall incidence of side effects, improvement rate of treatment, deterioration rate of treatment between two groups （ P 〉 O. 05 ）, except for initiating time of antibacterial and the monitoring efficiency（P 〈 0.05）. Conclusion Compared with the conventional guidance, the PCT has absolute advantage in guiding antibiotic initial treatment. But the expensive PCT testing and the lack of individual PCT- guidance programs as well as other factors have interfered with PCT to play its advantage in reducing the antibiotic costs, adverse reactions and deterioration rate. It can not completely replace the traditional experience and pathogen monitoring to guide independently antibiotic therapy in ICU.

关 键 词：降钙素原(PCT) 成本-效果分析 卫生经济学 抗生素 

分 类 号：R1[医药卫生—公共卫生与预防医学]