摘要
目的探讨血清降钙素原(PCT)水平对尿脓毒血症患者停用抗菌药物时机的指导价值。方法根据随机数字表将62例尿脓毒血症患者分为实验组和对照组,每组31例。所有患者均根据脓毒症抗菌药物选择原则选用抗菌药物。对照组根据常规治疗原则停用抗菌药物,实验组则根据血清PCT水平的动态变化来指导抗菌药物的停用时机,以血清PCT水平绝对值降至≤0.25μg/L或降低程度≥峰值的90%为停药指证。比较2组患者的基线资料、抗菌药物使用时间、重症监护室(ICU)住院时间、总住院时间、28 d内感染复发率和感染相关死亡率。结果 2组患者年龄、性别、基础疾病合并情况、急性生理与慢性健康评分Ⅱ(APACHEⅡ)、感染菌分布情况比较差异均无统计学意义(P>0.05),具有可比性。实验组的抗菌药物使用时间显著低于对照组(P<0.05)。2组的ICU住院时间、总住院时间、28 d内感染复发率和感染相关死亡率比较,差异均无统计学意义(P>0.05)。结论对尿脓毒血症患者而言,血清PCT水平对停用抗菌药物的时机具有一定的指导价值,能显著缩短抗菌药物使用时间,且不影响患者的短期预后,安全可靠。
Objective To investigate the role of serum procalcitonin(PCT)level for guiding the discontinuation of antibiotics in patients with urinary sepsis.Methods A total of 62 patients with urinary sepsis were enrolled and classified into experimental group and control group according to random number table(31 patients for each group).All patients received antibiotics according to the principle of antimicrobial usage for sepsis.The control group was treated according to the principle of rational antimicrobial usage.The experimental group discontinued antibiotics according to the dynamic changes of serum PCT level.The discontinuation indication was that serum PCT level was≤0.25μg/L or serum PCT level had decreased by≥90%of its peak value.Baseline data,antimicrobial drug use time,intensive care unit(ICU)stay time,total hospitalization time,the recurrence incidence of infection and the infection-related death rate in 28 d were compared between the 2 groups.Results There was no statistical significance in age,sex,complication diseases,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and the distribution of infectious bacteria between the 2 groups(P>0.05)with comparability.Antibiotic use time in experimental group was lower than that in control group(P<0.05).There was no statistical significance for ICU stay time,total hospitalization time,the recurrence incidence of infection and the infection-related death rate in 28 d between the 2 groups(P>0.05).Conclusions For patients with urinary sepsis,serum PCT level can guide the discontinuation of antibiotics.It could shorten antibiotic use time and could not affect short-term prognosis,which is safe and reliable.
作者
陈晓艳
CHEN Xiaoyan(Department of Clinical Laboratory,Luodian Hospital of Baoshan District,Shanghai 201908,China)
出处
《检验医学》
CAS
2018年第9期794-797,共4页
Laboratory Medicine
