基于降钙素原水平指导抗生素联合连续性血液净化治疗重症急性胰腺炎的效果

Influence of antibiotics combined with continuous blood purification on prognosis and immune homeostasis in patients with severe acute pancreatitis based on procalcitonin monitoring level

目的探讨基于降钙素原(PCT)监测水平指导应用抗生素联合连续性血液净化(CBP)对重症急性胰腺炎(SAP)患者预后转归及免疫内稳状态的影响。方法选取2020年2月至2022年6月赣州市人民医院收治的80例SAP患者作为研究对象,按照随机数字表法分为研究组与对照组,每组40例。入院后两组均采取常规干预、CBP,对照组在上述基础参照SAP诊治指南抗生素应用原则给予抗生素治疗,研究组每天监测PCT指导应用抗生素。比较两组预后转归效果、治疗情况、治疗前后免疫内稳状态相关指标水平。结果研究组治疗总有效率为90.00%,高于对照组的72.50%,差异有统计学意义(P<0.05)。研究组抗生素应用时间、CBP时间、住院时间均短于对照组,住院治疗费用少于对照组,差异有统计学意义(P<0.05)。治疗后,两组CD4^(+)、CD8^(+)水平及CD4^(+)/CD8^(+)均高于治疗前,白细胞介素-1(IL-1)、干扰素γ(IFN-γ)水平均低于治疗前,且研究组CD4^(+)、CD8^(+)水平及CD4^(+)/CD8^(+)均高于对照组,IL-1、IFN-γ水平均低于对照组,差异有统计学意义(P<0.05)。结论基于PCT监测水平指导应用抗生素联合CBP治疗SAP可缩短治疗时间,改善机体免疫内稳状态,增强治疗效果,有助于减轻家庭经济负担。

Objective To investigate the effect of antibiotics combined with continuous blood purification(CBP)on the prognosis and immune homeostasis of patients with severe acute pancreatitis(SAP)based on the monitoring level of procalcitonin(PCT).Methods A total of 80 SAP patients in Ganzhou People's Hospital from February 2020 to June 2022 were selected as the research subjects,and they were divided into the study group and the control group according to the simple random number table method,with 40 cases in each group.After admission,two groups were given routine intervention and CBP,the control group was given antibiotic treatment according to the principles of antibiotic application in SAP guidelines for diagnosis and treatment on the basis of the above,and the study group was monitored daily by PCT to guide the application of antibiotics.The prognosis and outcome,treatment conditions,and levels of related indicators of immune homeostasis before and after treatment were compared between the two groups.Results The total effective rate of treatment in the study group was 90.00%,which was higher than 72.50%in the control group,the difference was statistically significant(P<0.05).The antibiotic application time,CBP time and hospitalization time in the study group were shorter than those in the control group,and the hospitalization cost was less than that in the control group,the differences were statistically significant(P<0.05).After treatment,the levels of CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)of the two groups were higher than those before treatment,the levels of IL-1 and IFN-γwere lower than those before treatment,and the levels of CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)in the study group were higher than those in the control group,the levels of IL-1 and IFN-γwere lower than those in the control group,the difference was statistically significant(P<0.05).Conclusion Based on the PCT monitoring level,the application of antibiotics combined with continuous blood purification in the treatment of SAP can shorten the treatment time,improve the immune homeostasis,improve the treatment effect of the disease,and help reduce the economic burden of the family.