骨折术后感染患者血清细胞因子变化及降钙素原指导抗菌药物应用效果研究  

Serum cytokines of fracture patients with postoperative infection and use of antibiotics under guidance of procalcitonin

作　　者：齐然 贾春霞 李桂云 薛彩霞 绳景亚 马红霞 QI Ran;JIA Chun-xia;LI Gui-yun;XUE Cai-xia;SHENG Jing-ya;MA Hong-xia(Luoyang Bone-setting Hospital of Henan Province,Luoyang,Henan 471002,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)风湿病科,河南洛阳471002 [2]河南省洛阳正骨医院(河南省骨科医院)脊柱外三科,河南洛阳471002 [3]河南省洛阳正骨医院(河南省骨科医院)骨肿瘤科,河南洛阳471002 [4]河南省洛阳正骨医院(河南省骨科医院)检验中心,河南洛阳471002 [5]河南省洛阳正骨医院(河南省骨科医院)骨髓炎科,河南洛阳471002 [6]河南省洛阳正骨医院(河南省骨科医院)髋部损伤科,河南洛阳471002

出　　处：《中华医院感染学杂志》2019年第1期110-112,116,共4页Chinese Journal of Nosocomiology

基　　金：河南省中医药科学研究基金资助项目(2017ZY2117)

摘　　要：目的探讨骨折术后感染患者血清细胞因子变化及降钙素原(PCT)指导抗菌药物应用效果,为骨折术后感染的临床诊治提供参考。方法选取2016年6月-2017年10月在医院行骨折手术治疗术后发生感染患者50例为研究对象,随机分为PCT指导组与无PCT指导组各25例。无PCT指导组患者根据医师治疗经验给予抗菌药物指导用药,PCT指导组根据PCT检测结果进行抗菌药物指导治疗,观察治疗前及治疗7d时患者血清PCT、白细胞介素-6(IL-6)、白细胞介素12(IL-12)、白细胞介素23(IL-23)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)水平变化,比较两组患者治疗期间应用抗菌药物时间、住院时间。结果PCT指导组与无PCT指导组患者治疗前血清PCT、IL-6、IL-12、IL-23、TNF-α、CRP指标水平比较差异无统计学意义,治疗后均低于治疗前,比较差异有统计学意义(P<0.05),且PCT指导组降低幅度低于无PCT指导组,比较差异有统计学意义(P<0.05);PCT指导组应用抗菌药物时间及住院时间均短于无PCT指导组(P<0.05)。结论骨折术后感染患者根据PCT监测结果指导抗菌药物应用可提高治疗疗效,缩短抗菌药物应用时间。OBJECTIVE To explore the changes of serum cytokines of the fracture patients with postoperative infection and analyze the effect of use of antibiotics under guidance of procalcitonin(PCT)so as to provide guidance for clinical diagnosis and treatment of the fracture patients with postoperative infection.METHODS From Jun 2016 to Oct 2017,a total of 50 fracture patients who had infection after the surgical procedures were recruited as the study objects and randomly divided into the PCT-guided group and the non-PCT-guided group,with 25 cases in each group.The PCT-guided group was treated with antibiotics based on the result of test of PCT.The levels of serum PCT,interleukin-6(IL-6),interleukin-12(IL-12),interleukin-23(IL-23),tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)of the patients were observed before the treatment and on the 7 th day of treatment;the time of use of antibiotics and length of hospital stay were observed and compared between the two groups of patients.RESULTS There were no significant differences in the levels of serum PCT,IL-6,IL-12,IL-23,TNF-αand CRP between the PCT-guided group and the non-PCT-guided group before the treatment,and the levels of the above indexes were significantly lower after the treatment than before the treatment(P<0.05);the levels of the above indexes were reduced significantly in the PCT-guided group than in the non-PCT-guided group(P<0.05).The time of use of antibiotics and length of hospital stay of the PCT-guided group were significantly shorter than those of the non-PCT-guided group(P<0.05).CONCLUSIONThe PCT-guided use of antibiotics may improve the curative effect of the fracture patients with postoperative infection and shorten the time of use of antibiotics.

关 键 词：骨折 术后 感染 细胞因子 降钙素原 抗菌药物 

分 类 号：R681.2[医药卫生—骨科学]