降钙素原动态监测在指导重症急性胰腺炎抗菌治疗中的意义

Clinical significance of dynamic procalcitonin monitoring for guidance of antibiotic treatment of severe acute pancreatitis

目的探讨降钙素原(PCT)动态监测在重症急性胰腺炎(SAP)抗菌治疗中的指导意义。方法将75例SAP患者按随机数字表法分为试验组38例,对照组37例,两组患者均给予常规治疗。试验组监测患者血清PCT浓度,当患者出现感染症状体征且PCT值>0.5μg/L时给予抗感染治疗,症状体征改善且PCT值<0.5μg/L超过3 d或PCT值下降90%基础值并持续3 d则停止抗菌治疗;对照组按常规应用抗菌药物。比较两组患者抗菌药物使用时间、抗菌药物累计消耗量(c DDDs)、住院时间、住院费用、病死率等。结果实验组抗菌药物使用时间、ICU住院时间、总住院时间明显短于对照组(P<0.05),c DDDs、住院费用明显少于对照组(P<0.05);两组病死率比较,差异无统计学意义(P>0.05)。结论监测PCT水平以指导SAP抗菌药物应用,可显著减少抗菌药物使用时间及使用量,并可减少住院时间,降低住院费用。

Objective To investigate the clinical significance of dynamic procalcitonin（PCT） monitoring for the guidance of antibiotic treatment of severe acute pancreatitis（SAP）.Methods Seventy-five patients with SAP were randomly divided into experimental group（n=38） and control group（ n=37） .The patients in the two groups were given routine treatment.The patients in the experimental group received serum PCT concentration monitoring,and were given antibiotic treatment when they appeared infection symptoms and their PCT concentrations were higher than 0.5μg/L.But the antibiotic treatment were stopped when the patients′symptoms improved and the duration of their PCT concentrations〈0.5μg/L was more than three days,or when their PCT concentrations decreased to 90%of the baseline and lasted for three days.The control group was given routine antibacterial medication.Antibiotic treatment duration, antibiotic cumulative defined daily doses （ cDDDs） ,hospital stay,hospitalization cost,mortality and other indicators were compared between two groups.Results The experimental group achieved significantly shorter antibiotic treatment duration,ICU hospital stay and overall hospital stay as well as significantly less cDDDs and hospitalization cost compared with control group（P〈0.05）.There was no significant difference in the mortality between two groups （P〉0.05）.Conclusion PCT monitoring for guiding antibiotic treatment of SAP might significantly reduce the antibiotic consumption and duration of antibiotic treatment as well as reduce hospital stay and hospitalization cost.