降钙素原水平对指导脓毒症患者停用抗菌药物时机的有效性和安全性评估  

Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment of sepsis patients

作　　者：许晓兰[1] 严凤娣[1] 於江泉[1] 陈齐红[1] 林华[1] 郑瑞强[1] Xu Xiaolan Yan Fengdi Yu Jiangquan Chen Qihong Lin Hua Zheng Ruiqiang.(Department of Intensive Care Medicine, Northern Jiangsu People＇s Hospital, Yangzhou 225001, China)

机构地区：[1]江苏省苏北人民医院重症医学科,江苏省扬州市225001

出　　处：《中华医学杂志》2017年第5期343-346,共4页National Medical Journal of China

基　　金：江苏省重点专科项目江苏省苏北人民医院基金（yzucms201311）

摘　　要：目的评估降钙素原（PCT）指导重症医学科（ICU）脓毒症患者抗生素使用的有效性以及安全性。方法2013年1月至2015年12月江苏省苏北人民医院重症医学科纳入因可疑感染或者确诊感染使用抗生素的脓毒症患者156例，按照随机数字表法分为PCT指导抗菌药物治疗组（PCT组）79例和常规抗菌药物治疗组（RAT组）77例。所有患者初始抗生素的选用均依据脓毒症抗菌药物应用原则选择抗菌药物，其中PCT组则每日监测患者PCT，以PCT下降超过峰值90％或PCT绝对值≤0．25μg/L作为停用抗菌药物指征，RAT组按照脓毒症的抗菌药物治疗原则停用抗菌药物。比较两组患者的一般情况、抗菌药物使用时间、ICU时间、住院时间、28d感染复发率及28d病死率。结果两组患者在年龄、性别、细菌学阳性率、合并慢性基础疾病等一般情况差异无统计学意义（P〉0．05）。其中，PCT组APACHEII评分（22．7±4．7）分，高于RAT组（19．9±4．2）分（P〈0．05）。PCT组抗菌药物使用时间明显短于RAT组（P〈0．05）。两组患者的住院时间、ICU住院时间、28d感染复发率及28d病死率差异均无统计学意义（均P〉0．05）。结论依据PCT停用ICU脓毒症患者抗菌药物可以缩短抗菌药物使用时间，且不影响住院时间、ICU住院时间、28d感染复发率及28d病死率。Objective To assesse the efficacy and safety of procalcitonin-guided antibiotic treatment of sepsis patients in intensive care units （ICU）. Methods A prospective, randomised, controlled trial was gone in ICU of Northern Jiangsu People＇s Hospital. Between January 2013 and December 2015. One hundred and fifty-six patients assessed for eligibility were randomly assigned to the procalcitonin-guided group （PCT group, 79） or to regular antibiotic group （RAT group, 77）. Patients who received antibiotics for presumed infection according to principle of antimicrobial usage. In the procalcitonin-guided group, a non-binding advice to discontinue antibiotics was provided if procalcitonin concentration had decreased by 90% or more of its peak value or to 0. 25 μg/L or lower. In the regular antibiotic group, patients were treated according to principle of antimicrobial usage. The general status of the patient, antimicrobial drug use time, length of ICU stay, hospital stay time, number of cases of recurrence in 28 days and number of cases of death in 28 days were compared between the two groups. Results There were no statistical significance in age, gender, blood culture positive rate, and chronic underlying diseases （P 〉 0. 05）. While APACHE lI score of PCT group was （22. 7 ± 4. 7） points, which was higher than that of RAT group （ 19.9 ± 4. 2） （ P 〈 0. 05 ）. Log Rank test results showed that the time of antimicrobial drug usage was significantly reduced in PCT group than RAT group [ days： 8.3 ± 0. 3, 95% confidence interval （95% CI 7.9 - 9. 1 ） vs 10.1 ± 0.4, 95% confidence interval （95% CI 9. 2 - 11.3）, Log Rank value 31.85, P =0. 000]. There was no significant difference in length of hospital stay, ICU stay time, number of cases of recurrence in 28 days and number of death in 28 days between two groups （P 〉0. 05 ）. Conclusion Procalcitonin guidance stimulates reduction of duration of treatment and daily defined doses in critically ill patients with a presumed bacterial i

关 键 词：脓毒症 降钙素 抗生素类 

分 类 号：R459.7[医药卫生—急诊医学]