降钙素原指导急性重症胰腺炎抗菌药物应用的临床研究

Clinical significance of dynamic monitoring of procalcitonin in guiding use of antibiotics in patients with severe acute pancreatitis

目的探讨血清降钙素原(PCT)动态变化指导急性重症胰腺炎(SAP)患者抗菌药物应用的可行性和有效性。方法 72例SAP患者分为常规抗菌药物治疗组(C组)和PCT指导抗菌药物治疗组(P组),每组36例。C组患者根据经验指导抗菌药物使用,P组入院后每日监测PCT变化,PCT>0.5ng/ml为抗菌药物启用指征,PCT<0.5ng/ml或下降90%基础值并持续三天为抗菌药物停用指征。比较两组患者的抗菌药物治疗时间、抗菌药物累计DDD数、胰腺外感染发生率、局部穿刺引流率、ICU住院时间、总住院时间、住院死亡率。结果 C组抗菌药物使用时间为(14.8±2.6)天,P组为(12.0±1.6)天,两组比较差异有统计学意义(P<0.05),C组抗菌药物累计DDD数显著高于P组(P<0.05);C组患者胰腺外感染发生率高于P组(P<0.05);P组患者ICU住院时间、总住院时间显著低于C组(P<0.05)。结论在SAP患者中监测PCT动态变化并作为抗菌药物使用的主要参考指标是临床工作中安全有效且可行的方案。

Objective To research the role of daily procalcitonin （PCT） serum determinations for guiding antibiotic treatment in patients with severe acute pancreatitis （SAP）.Methods 72 patients with SAP were randomly assigned to two groups （36 cases in each group）.In the conventional treatment group （group C）,antibiotic therapy was based on the experience of physicians.Antibiotic therapy in the PCT-guided group （group P） was not applied until the PCT value was ＞0.5ng/ml,PCT value decreased over 90％ or PCT value lower than 0.5μg/L over 3 days time point were selected as drug withdrawal indication.Following indicators were compared between two groups：antibiotic therapy time,the cumulative number of DDD,occurrence of other system infection,the incidence of local drainage,the duration of intensive care unit stay,all length of hospitalization,in-hospital mortality.Results The antibiotic therapy time was significantly shorter in group P compared with group C（P＜0.05）,the cumulative number of DDD of group P was significantly lower than that of group C（P＜0.05） ; the duration of intensive care treatment,all length of hospitalization,incidence of other system infection in group P were significantly lower than those in group C.Conclusion PCT is a effective and feasible indicator for guiding the use of antibiotics in patients with SAP.