血清前降钙素指导严重多发伤患者抗生素使用的效果分析

Effects of Serum Procalcitonin-Guided Therapy in ICU Patients with Severe Multiple Trauma

目的:探讨血清前降钙素(PCT)水平对于重症监护病房内严重多发伤病人抗生素使用的指导意义。方法:选取入住荆州市中心医院ICU的严重多发伤患者81例,经纳入排除后,将最后纳入研究的患者70例随机分为对照组和试验组。其中对照组(32例)根据医生判断和经验使用抗生素;试验组(38例)根据PCT水平使用抗生素。观察两组患者抗生素使用时间、抗生素费用、ICU住院天数、治疗中SOFA变化、多器官功能障碍综合征(MODS)发生率、感染发生率、脓毒症发生率以及患者28d内死亡率。结果:试验组的平均抗生素使用时间为(12.0±5.31)d,显著短于对照组的(16.6±7.8)d,差异有统计学意义(P<0.05),抗生素费用亦显著低于对照组[(4931.9±2824.9)元vs(7004.3±3755.1)元,P<0.05]。比较两组患者ICU住院天数(12.08±9.72)d vs(12.72±8.58)d、治疗中SOFA变化(4.66±2.83)vs(4.88±2.79)、MODS发生率(6/38 vs 7/32)、感染发生率(22/38 vs 21/32)、脓毒症发生率(13/38 vs 10/32)以及28d内死亡率(3/38 vs 5/32),结果均无统计学差异(P>0.05)。结论:在PCT指导下使用抗生素,可以缩短ICU内严重多发伤患者的抗生素使用时间,减少抗生素费用。

Objective:To evaluate the clinical effects of serum procalcitonin(PCT)on guiding antibiotic therapy for ICU patients with severe multiple trauma Methods:70cases of severe multiple trauma patients in the Central Hospital of Jingzhou had been chosen from 81 cases in total and had been randomly assigned into two groups:the control group(n=32)and the experimental group(n=38).In the control group the antibiotic use had been based on judgment and experience of physicians.In the experimental group the antibiotic use had been based on PCT concentration during hospitalization.The time of antibiotic use,costs of antibiotics,ICU hospitalization days,SOFA changes in treatment,the incidence of multiple organ dysfunction syndromes(MODS),infection and sepsis and patient mortality within 28 days had been observed.Results:In the experimental group,the duration of antibiotic therapy was significantly shorter than the control group[(12.0±5.31)d vs(16.6±7.8)d,P<0.05],and the costs of antibiotic were significantly lower than the control group [$(4931.9±2824.9)vs$(7004.3±3755.1),P <0.05].There were no statistical differences(P >0.05)in the ICU hospitalization days(12.08±9.72dvs12.72±8.58d),SOFA changes(4.66±2.83 vs 4.88±2.79),the incidence of MODS(6/38 vs 7/32),infection(22/38 vs 21/32)and the sepsis(13/38 vs 10/32),and mortality(3/38 vs 5/32)within 28 days.Conclusion:PCT can be effectively used for guiding antibiotic treatment in severe multiple trauma patients in the ICU,which may contribute to shortening the duration of antibiotic therapy and reducing the costs of antibiotic.