降钙素原监测指导呼吸机相关性肺炎患者抗菌药物使用的价值  

Procalcitonin Monitoring for Guiding Antimicrobial Use in Patients with Ventilator-Associated Pneumonia

作　　者：李志莹[1] 杜秀芳[1] 陈济明[1] 陈延伟[1] 

机构地区：[1]广东医学院附属南山医院呼吸内科,广东深圳518052

出　　处：《实用临床医学（江西）》2017年第6期19-21,共3页Practical Clinical Medicine

摘　　要：目的探讨监测降钙素原(procalcitonin,PCT)动态水平对指导呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)患者抗菌治疗的有效性和安全性。方法将35例VAP患者依据抗生素使用的不同分为PCT指导的抗菌治疗组(PCT组,20例)和抗菌素经验治疗组(对照组,15例),2组患者在开始使用抗生素时和使用抗生素第3、7和第10天抽取静脉血检测PCT,PCT组在PCT检测值<0.25ng·mL-1时停用抗生素,对照组根据医生的临床经验使用抗生素。比较2组患者抗生素使用时间、呼吸机使用时间、住院时间、停药后7d内感染复发率和30d内的病死率。结果与对照组相比,PCT组抗生素使用时间较对照组缩短(P<0.05)。2组患者机械通气、住院时间、停药后7d内感染复发率和30d内病死率比较差异均无统计学意义(均P>0.05)。结论监测PCT可使VAP治疗决策更有效,可减少VAP患者抗菌药物的过度使用且无明显不良后果。Objective To investigate the efficacy and safety of dynamic monitoring of procalcitonin（PCT）in the guidance of antimicrobial use in patients with ventilator-associated pneumonia（VAP）.Methods Thirty-five patients with VAP were assigned to receive either PCT-guided antimicrobial treatment（PCT group,n=20）or empirical antibiotic treatment（control group,n=15）.Venous blood samples were collected at the beginning of treatment and on the 3rd,7th and10 th days of treatment to measure the levels of PCT.Antibiotics were withdrawn when PCT level was below 0.25ng·mL-1.Antibiotic treatment duration,ventilation duration,hospital stay,infection recurrence rate within 7days after antibiotic withdrawal and mortality rate within 30 days were compared between the two groups.Results Antibiotic treatment duration in PCT group was shorter than that in control group（P〈0.05）.There were no significant differences in ventilation duration,hospital stay,infection recurrence rate within 7days after antibiotic withdrawal and mortality rate within 30 days between the two groups（P〉0.05）.Conclusion The monitoring of PCT provides a guidance for VAP treatment decision making and reduces excessive use of antimicrobial agents without obvious adverse consequences.

关 键 词：降钙素原 呼吸机相关性肺炎 抗菌药物 

分 类 号：R563.1[医药卫生—呼吸系统]