动态监测降钙素原对ICU脓毒症患者抗菌药物使用的临床意义  

Clinical significance of dynamic monitoring of procalcitonin in guiding the use of antibiotics in patients with sepsis in ICU

作　　者：刘宝华[1] 李海峰[1] 雷宇[1] 赵士兴[1] 孙明莉[1] 

机构地区：[1]吉林大学第一医院二部急救医学科,长春130031

出　　处：《中华危重病急救医学》2013年第11期690-693,共4页Chinese Critical Care Medicine

基　　金：卫生部国家临床重点专科建设项目（2012-650）

摘　　要：目的 探讨动态监测降钙素原（PCT）指导重症监护病房（ICU）脓毒症患者抗菌药物使用的临床价值.方法 选择2012年1月至2013年6月在吉林大学第一医院ICU住院的脓毒症患者82例,按随机数字表法分为常规抗菌药物治疗组（RAT组,40例）及PCT监测指导抗菌药物治疗组（PCT组,42例）.RAT组按脓毒症的抗菌药物治疗原则选择及停用抗菌药物；PCT组在此基础上每天监测PCT,以无活动感染症状以及急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分下降,PCT下降超过90％或PCT＜0.25 μg/L作为停药指征.对比两组患者一般情况、抗菌药物使用时间及预后情况；用Kaplan-Meier法进行生存曲线分析.通过重复测量资料的方差分析对两组生存患者和死亡患者血清PCT水平进行1～7d的动态观察.结果 Mann-Whitney U检验或x2检验结果显示,两组患者年龄、性别比、APACHEⅡ评分,血培养和痰培养阳性率,心功能不全、肾功能不全、呼吸衰竭、呼吸机使用及血液滤过等一般情况比较差异无统计学意义（均P＞0.05）.Log Rank检验结果显示,PCT组抗菌药物使用时间较RAT组明显缩短[d：8.1±0.3,95％可信区间（95％CI 8.3～9.7）比9.3±0.3（95％CI8.7～ 10.1）,P=0.013].Kaplan-Meier法进行单因素生存曲线分析发现,PCT组比RAT组的生存曲线下降速度较快,提示抗菌药物使用时间缩短.两组患者住院时间、ICU滞留时间、28 d死亡例数、28 d复发例数及临床治愈率差异均无统计学意义（均P＞0.05）.两组死亡患者PCT水平比生存患者要明显升高,在治疗前期和治疗后期均超过10 μg/L.结论 动态监测PCT可以有效缩短ICU脓毒症患者抗菌药物的使用时间,且患者预后无明显差异.Objective To investigate the significance of dynamic monitoring of procalcitonin （PCT） in guiding the use of antibiotics for treating patients with sepsis in intensive care unit （ICU）.Methods Eighty-two patients with sepsis from January 2012 to June 2013 hospitalized in ICU of First Hospital of Jilin University were enrolled,and they were randomly divided into regular antibiotic therapy group （RAT group,n =40） and PCT monitoring in guiding the use of antibiotics group （PCT group,n =42）.Patients in RAT group were treated according to principle of antibiotics usage,while in PCT group patients＇PCT value was observed everyday.When no active symptoms of infection were shown,and acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） scores declined,PCT value decreased over 90％ or PCT value lower than 0.25 μg/L time point were selected as drug withdrawal indication.The general status of the patient,antimicrobial drug use time,and prognosis were compared between the two groups,and Kaplan-Meier method was used for survival curve analysis.Variance analysis was used for repeating measurement to observe dynamic serum PCT level of the two groups of patients for survival and death during 7 days.Results Mann-Whitney U test or x2 test showed that there were no statistical significance in age,gender,APACHE Ⅱ score,blood culture positive rate,sputum culture positive rate,cardiac insufficiency,renal failure,respiratory failure,and ventilator and hemofiltration usage （all P＞0.05）.Log Rank test results showed that the time of antimicrobial drug usage was significantly reduced in PCT group than that in RAT group [days：8.1 ± 0.3,95％ confidence interval （95％ CI 8.3-9.7） vs.9.3 ± 0.3 （95％ CI 8.7-10.1）,P=0.013].Kaplan-Meier univariate survival curves showed that the speed of curve declination in PCT group was faster significantly than that in RAT group,suggesting that the time of using antimicrobial drug was shortened.There was no significant difference in length of hospital stay

关 键 词：脓毒症 降钙素原 抗菌药物 

分 类 号：R459.7[医药卫生—急诊医学]