降钙素原与CRP测定对急性上消化道穿孔术后抗生素应用的作用  

EFFECT OF DETERMINATION OF PROCALCITONIN AND C-REACTIVE PROTEIN ON ANTIBIOTIC USE IN PATIENTS AFTER SURGERY FOR ACUTE UPPER GASTROINTESTINAL TRACT PERFORATION

作　　者：李伟 刘鹏 王智浩 李玲 

机构地区：[1]青岛市黄岛区第二人民医院外二科,山东青岛266400

出　　处：《齐鲁医学杂志》2016年第5期544-546,共3页Medical Journal of Qilu

摘　　要：目的探讨急性上消化道穿孔术后测定血清降钙素原（PCT）及C反应蛋白（CRP）对抗生素应用的指导意义。方法选取86例急性上消化道穿孔病人随机分成观察组（PCT组）和对照组,各43例,比较两组术后抗生素应用情况。观察组分别在术后第1、3及5天测定病人血清PCT及CRP水平,在PCT正常（〈0.5μg/L）时停用抗生素,对照组则按照传统标准停止使用抗生素。比较两组病人抗生素应用时间、术后恢复情况、并发症发生率及PCT、CRP等指标。结果两组病人术后并发症发生率比较差异无统计学意义（P〉0.05）。观察组抗生素应用时间、术后住院时间及住院费用均低于对照组,差异有统计学意义（t=2.260~3.236,P〈0.05）。观察组（未感染组和感染组）术前PCT及CRP水平比较,差异无显著性（P〉0.05）。术后第1天未感染组PCT水平有所下降,术后第3、5天下降明显,差异有显著性（F=205.83,P〈0.01）;术后CRP水平先升高后降低,术后第1、3天与术前比较差异有显著性（F=422.03,P〈0.05）。感染组术后第1、3、5天PCT、CRP水平均高于未感染组,差异有显著性（t=4.086~17.032,P〈0.05）。结论联合监测PCT及CRP值对急性上消化道穿孔术后抗生素应用的指导作用要优于传统标准。Objective To investigate the guiding significance of antibiotic application after surgery of acute upper gastrointestinal tract perforation（AUGTP）through determining serum procalcitonin（PCT）and C-reactive protein（CRP）. Methods Eighty-six patients with AUGTP were selected and equally divided into two groups as：PCT group and control group.Their posto-perative use of antibiotics was compared.The serum PCT and CRP in patients of the PCT group were detected on days 1,3and5 afetr the surgery.When PCT was normal（〈0.5μg/L）,antibiotics were discontinued.For those in the control group,the stop using antibiotics was in accordance with traditional standards.A comparison was carried out between the two groups in terms of antibiotic application time,postoperative recovery,complications,PCT and CRP. Results The difference in incidence of postoperative complications in patients between the two groups was not statistically significant（P〉0.05）.The time of antibiotic use,postoperative hospital stay and hospitalization expence in PCT group was lower versus control group（t=2.260-3.236,P〈0.05）.The differences in preoperative PCT and CRP levels between uninfected and infected subgroups in PCT group were not significant（P〉0.05）.On the first day after surgery,PCT levels of the uninfected group decreased,on days 3and 5,the decrease of PCT became significant（F=205.83,P〈0.05）.In infected subgroup,on days 1,3and 5after surgery,the levels of CRP and PCT were higher than that in uninfected subgroup（t=4.086-17.032,P〈0.05）. Conclusions Combined monitoring of PCT and CRP values is superior to the traditional standard in guiding antibiotic application after surgery of acute upper gastrointestinal perforation.

关 键 词：降钙素原 C-反应蛋白质 消化道穿孔 抗菌药 

分 类 号：R656.1[医药卫生—急诊医学]