血清PCT对复杂腹腔感染患者抗菌药物治疗的指导价值  

Value of serum PCT in the treatment of patients with complex abdominal infections

作　　者：王轶伟[1] 郭仁德[1] 宋冰[1] 王毅[1] 高宇[1] WANG Yi-wei;GUO Ren-de;SONG Bing;WANG Yi;GAO Yu(Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院普通外科,天津300192

出　　处：《中华医院感染学杂志》2018年第15期2337-2340,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81172103)

摘　　要：目的探究血清降钙素原(PCT)的变化值对短期抗菌药物治疗复杂腹腔感染患者的指导作用。方法选取2013年1月-2016年12月于医院住院并接受治疗的复杂腹腔感染患者96例为研究对象,按照随机数表法分为试验组和对照组,各48例。测定两组患者入院时的PCT水平,在两组患者经手术治疗后每24h测定一次PCT水平。试验组患者在测定PCT值<0.4ng·ml-1或低至PCT1值的30%以下且临床全身炎症反应综合征(Systemic Inflammatory Response Syndrome,SIRS)症状有所消除后即可停止相应的抗菌药物治疗。对照组患者在SIRS症状消失且体温和白细胞数量恢复正常水平3天后即可停止相应的抗菌药物治疗。比较两组患者术后的手术部位感染情况、30d内患者死亡情况、30d内腹腔感染复发情况、首次抗菌药物治疗时间、30d内无抗菌药物治疗时间和住院时间。结果 96例复杂腹腔感染患者共检出病原菌93株,其中革兰阳性菌24株占25.81%、革兰阴性菌18株占19.35%、真菌51株占54.84%;试验组患者首次使用抗菌药物治疗的时间为(5.2±0.9)d,短于对照组患者的(8.7±1.3)d(t=2.693,P=0.007);试验组患者30天内感染复发例数为3例,优于对照组患者复发例数8例(χ2=4.214,P=0.043);试验组患者30天内无抗菌药物辅助治疗的时间为(22.6±2.8)d,长于对照组患者的(16.3±2.4)d(t=2.748,P=0.006)。结论临床依据血清PCT变化的水平可对复杂腹腔感染患者的抗菌药物治疗起到指导作用,在短期内缩短患者对抗菌药物的依赖性,同时减少了患者的死亡率和感染的复发率。OBJECTIVE To investigate the effect of changes of serum procalcitonin（PCT）on short-term antibiotic therapy in patients with complex abdominal infection.METHODS A total of 96 cases of patients with complex abdominal infection who were hospitalized and treated in our hospital from Jan.2013 to Dec.2016 were selected,and divided into observation group and control group according to the random number table method,with 48 cases in each group.The levels of PCT of both groups were measured at the time of admission,and PCT levels were measured every 24 hours after surgery in both groups.Patients in the observation group stopped the corresponding antibiotic treatment after measuring a PCT value of less than 0.4 ng·ml^-1 or less than 30% of the PCT1 value and the clinical SIRS symptoms were eliminated.Patients in the control group stopped the corresponding antibiotic treatment after SIRS symptoms disappeared and the body temperature and white blood cell count returned to normal levels for 3 days.The surgery sites of infections,30 days of death,30 days of abdominal infection recurrence,the first antibiotic treatment time,30 days without antibiotic treatment time and length of stay between the two groups of patients were compared.RESULTS Totally 93 strains of pathogenic bacteria were detected in 96 cases of complex abdominal infections.Among them,24 strains of gram-positive bacteria accounted for 25.81%,18 strains of gram-negative bacteria accounted for 19.35%,and 51 strains of fungi accounted for 54.84%.The first antibiotic treatment time in the observation group was（5.2±0.9）d,which was significantly lower than that（8.7±1.3）d in the control group（t=2.693,P=0.007）.The number of recurrence cases in the observation group was 3 cases,which was better than 8 cases in the control group（χ^2=4.214,P=0.043）.The time for no antibiotic adjuvant therapy within 30 days in the observation group was（26.6±2.8）d,which was significantly longer than（16.3±2.4）d in the control group（t=2.748,P=0.006）.CONCLUSI

关 键 词：血清降钙素原 复杂腹腔感染 抗菌药物治疗 指导作用 

分 类 号：R656[医药卫生—外科学]