降钙素原对重型颅脑损伤并发颅内感染后抗生素使用的指导意义

Value of serum procalcitonin monitoring to guiding antibiotic treatment of patients with intracranial infection after severe traumatic brain injury

目的探讨动态监测血清降钙素原（PCT）对指导重型颅脑损伤并发颅内感染患者抗生素使用的临床价值。方法选取91例重型脑损伤合并颅内感染的患者，随机分为PCT监测治疗组（45例，PCT组）和常规治疗组（46例，对照组）。相同的诊疗基础上，对照组根据抗生素应用指南决定疗程。PCT组根据血清PCT检测值判断是否继续或停止使用抗生素，当血清PCT≥0．25ng，ml时，进行抗生素治疗；PCT〈0．25ng／ml时，停止抗生素治疗。结果PCT组抗生素疗程8～15d，平均（12．35±2．47）d；对照组抗生素疗程11—19d，平均（15．78±2．69）d；PCTfR患者抗生素疗程明显少于对照组（P〈0．05）。治疗后，两组患者全身炎症反应综合征修正评分较治疗前明显改善（P〈0．05），但两组之间无统计学差异（P〉0．05）。结论重型颅脑损伤并发颅内感染患者根据PCT使用抗生素，能够缩短抗生素疗程，动态监测PCT水平可作为优化抗生素治疗的有效指标。

Objective To explore the clinical value of serum procalcitonin monitoring to guiding the antibiotic treatment of patients with intracranial infection after severe traumatic brain injury （STBI）. Methods Ninety-one patients with intracranial infection after STBI were randomly divided into two groups, i.e., procalcitonin monitoring group （n=45） and control group （n=46）. The patients in the control group received antibiotic treatment on the basis of Antibiotic Application Guide in China. The patients in procalcitonin monitoring group received antibiotic treatmenl according the serum level of procalcitonin （antibiotic treatment was performed on the serum level of procalcitonin ≥0.25 ng/ml; the antibiotic treatment stopped on it 〈0.25 ng/ml）. Results The adjusted systemic inflammatory response syndrome scores significantly improved in both the procalcitonin monitoring group and control group after antibiotic treatment compared to those before the treatment （P〈0.05）, but there was no significant difference in them between the two groups after treatment （P〉0.05）. The duration-[（12.35±2.47）days] of antibiotic treatment was significantly decreased in the procalcitonin monitoring group compared with that [（15.78 ± 2.69）days] in the control group （P〈0.05）. Conclusion Monitoring of the serum procalcitonin can be used for guiding the antibiotic treatment in the patients with intracranial infection after severe traumatic brain injury.