血清PCT对危重新生儿应用抗菌药物的指导价值

Guidance value of serum PCT in the antibacterial drugs use for critically ill neonates

目的探讨血清降钙素原(PCT)对危重新生儿应用抗菌药物的价值,以指导临床合理使用抗菌药物。方法纳入186例住院危重新生儿,其中,未应用抗菌药物的124例新生儿作为对照组,应用抗菌药物的62例新生儿为观察组。对比分析患儿住院时的体温状况和住院后的PCT、白细胞计数(WBC)、C-反应蛋白(CRP)和红细胞沉降率(ESR),并记录入选患儿预后状况。记录观察组患儿使用抗菌药物当天的PCT、WBC、CRP、体温,以及用药3 d后的PCT水平和体温状况。结果观察组患儿医院感染部位分布情况:肠道感染28例,占45.2%;上呼吸道感染17例,占27.4%;下呼吸道感染9例,占14.5%;泌尿道感染4例,占6.5%。两组患儿入院时的年龄、性别、体温、PCT、WBC、CRP、ESR和治愈例数[观察组:61例(98.39%),对照组121例(97.58%)]比较差异无统计学意义(P>0.05)。两组患儿预后情况比较差异无统计学意义(P>0.05),但观察组患儿的住院时间比对照组长(P<0.01)。观察组患儿在抗菌药物使用当日,PCT高于入院时(P<0.05),体温、WBC、CRP水平无显著变化(P>0.05);使用抗菌药物3 d后,患儿PCT比用药当日显著降低(P<0.05),体温比入院时和用药当日显著降低(P<0.05)。结论通过监测PCT可以指导危重新生儿的抗菌药物应用。

Objective To explore the guidance value of serum procalcitonin（ PCT） in the antibacterial drugs use for critically ill neonates. Methods 186 cases of critically ill neonates were chose,in which,62 cases used antibiotics（ observation group）,the other cases were allocated to control group. The body temperature of patients on admission and the PCT,WBC,CRP,ESR of patients after hospitalization were analyzed,the prognosis was recorded. The PCT,WBC,CRP and body temperature at the same day of medication,and the PCT,body temperature after 3 d of medication were recorded. Results The distribution of infection site in observation group： intestinal infection（ n = 28,45. 2%）,upper respiratory tract infection（ n = 17,27. 4%）,lower respiratory tract infection（ n = 9,14. 5%）,urinary tract infection（ n = 4,6. 5%）. There was no significant difference between the observation group and control group in age,gender,T,PCT,WBC,CRP,ESR on admission and the number of cure cases（ P 〉 0. 05）. There was no significant difference in prognosis between the 2 groups. The hospitalization time of observation group was longer than that of control group（ P 〈 0. 01）. The PCT in observation group raised（ P 〈 0. 05）,while the WBC,CRP and body temperature had no significant change（ P 〉 0. 05） at the same day of medication. After 3 d of treatment,the PCT reduced significantly（ P 〈 0. 05）,and the body temperature was lower（ P 〈 0. 05）. Conclusion Monitoring serum PCT can be applied to guide the antibacterial drugs use in critically ill neonates.