血清降钙素原在新生儿呼吸机相关性肺炎中的应用研究  

Application of serum procalcitonin level in neonatal ventilator-associated pneumonia

作　　者：熊伟[1] 程贵辉[1] 王英宏[1] 邱其周[1] 熊金国[1] 肖毅[1] 

机构地区：[1]518104,广州医科大学附属深圳沙井医院新生儿科

出　　处：《中国综合临床》2015年第4期-,共3页Clinical Medicine of China

基　　金：深圳市宝安区科技计划社会公益项目

摘　　要：目的：探讨血清降钙素原（PCT）在新生儿呼吸机相关性肺炎（VAP）中的表达及其临床意义。方法入选我院2013年6月至2014年12月新生儿重症监护病房（NICU）疑诊为 VAP 的患儿155例，按照是否发生 VAP 分为 VAP 组80例和非 VAP 组75例，经免疫发光法检测并比较两组患者第1天PCT。VAP 组再根据用药依据不同分为两组，各40例。对照组根据患儿情况由临床医师经验性使用抗生素；观察组使用抗生素需按其 PCT 水平：当 PCT ＞0.25μg/ L 时，使用抗生素进行治疗；治疗后若 PCT无下降，则更换抗生素；若 PCT 有下降，则继续使用同种抗生素。当 PCT ＜0.25μg/ L 时，停止用药。观察两组患儿第1、4、7、10天的 PCT 变化，比较治疗有效率和抗生素的使用情况。结果 VAP 组血清 PCT （1.68±0.13）μg/ L 显著高于非 VAP 组（0.10±0.02）μg/ L，差异有统计学意义（t =52.614，P ＜0.01）。观察组临床有效率87.5%（35/40）与对照组80.0%（32/40）比较差异无统计学意义（P =2.067）；治疗第4、7、10天时，观察组 PCT 均显著低于对照组，观察组的医疗费用（3525.8±1162.9）元及抗生素使用时间（10.3±2.7）d 同样低于对照组[（4706.7 ± 803.4）元，（13.5 ± 1.4）d]，差异有统计学意义（t 值分别为5.28、6.65，P 均 ＜0.01）。结论 VAP 新生儿的血清 PCT 显著升高，监测 PCT 可以指导临床合理使用抗生素。Objective To explore the expression and its clinical significance of serum procalcitonin (PCT)level in ventilator-associated pneumonia( VAP)in newborns. Methods One hundred and fifty-five children with suspected VAP in Shajing Hospital of Shenzhen Affiliated to Medical University of Guangzhou from June 2013 to December 2014 who were in intensive care kiunit(NICU)were selected as our subjects. According to whether they had VAP or not could be divided into VAP group(80 cases)and non-VAP group(75 cases). Immunoluminometric method was used to detect PCT level at 1st day. According to the different medicine,VAP group was divided into 40 cases of two groups. The control group was according to the situation of children which was used empirical antibiotic by clinicians. The observation group was given antibiotics according to the level of PCT(the antibiotics were used when PCT > 0. 25 μg/ L). After treatment,if PCT did not decrease,the antibiotics was replaced. If PCT decreased,the antibiotics was continued to use the same kind of antibiotics. While the PCT< 0. 25 μg/ L,the antibiotics were stopped using. The change of the PCT level at 1st,4th,7th,10th day of two groups were observed. Results Serum PCT level of VAP group was(1. 68 ± 0. 83)μg/ L,significantly higher than that of non-VAP((0. 10 ± 0. 02)μg/ L),and there was statistically significant difference( t = 52. 614,P< 0. 05). Clinical effective rate of observation group was 87. 5%(35 / 40),which was higher than that of the control group(80. 0%(32 / 40),P = 2. 067). At 4th,7th and 10th day after treatment,PCT expressions of the observation group were all significantly lower than those of the control group. The medical costs and antibiotic using time were significantly lower than those of the control group((3 525. 8 ± 1 162. 9)yuan vs.(4 706. 7 ± 803. 4),(10. 3 ± 2. 7)d vs.(13. 5 ± 1. 4)d;t = 5. 28,6. 65;P < 0. 05). Conclusion The serum PCT levels of newborns of VAP significantly increase,and monitoring the PCT can guide reasonably the use of antibiotics in

关 键 词：降钙素原 呼吸机相关性肺炎 新生儿 抗生素 

分 类 号：R5[医药卫生—内科学]