降钙素原监测对心脏术后抗生素使用的指导价值

Value of monitoring procalcitonin-guided antibiotics therapy after cardiac surgery

目的探讨降钙素原(PCT)监测对心脏术后预防性及治疗性抗生素使用的指导价值。方法将2015年4月至2015年9月在高州市人民医院心脏外科行心脏直视手术的简单先天性心脏病患者127人随机分为2组:A组62人为PCT监测指导使用抗生素组,B组65人为常规使用抗生素组。比较2组患者院内感染率、抗生素使用时间、ICU及术后总住院时间等指标。结果A组平均预防性抗生素使用时间为2.96 d,发生院内感染7例,平均治疗性抗生素使用时间为4.14 d;A组患者平均ICU治疗时间1.58 d,术后住院时间8.56 d,无死亡病例。B组平均预防性抗生素使用时间为5.36 d,发生院内感染6例,平均治疗性抗生素使用时间为5.86 d;B组患者平均ICU治疗时间为1.47d,术后住院时间8.87 d,无死亡病例;A组预防性及治疗性抗生素使用时间较B组明显减少,组间比较差异有统计学意义(P<0.05),而两组院内感染率、ICU时间及术后总住院时间比较差异均无统计学意义。结论降钙素原监测指导心脏术后抗生素使用可以明显减少抗生素使用时间,且具有良好的可行性、有效性和安全性。

Objective To explore the prophylactic and therapeutic value of monitoring procalcitonin-guided antibiotics therapy after cardiac surgery. Method Patients with simple congenital heart disease had open-heart surgery between April 2015 and September 2015 in our hospital were selected for the study. The patients were randomly divided into 2groups ： group A for monitoring procalcitonin-guided antibiotics therapy, group B for routine use of antibiotics. The nosocomial infections rate,antibiotic use time,ICU and postoperative hospital stay of the two groups were compared.Results In group A,the average prophylactic antibiotic use time was 2.96 days; there were 7 cases of nosocomial infection and the average therapeutic antibiotic use time was 14.14 days; the average ICU treatment time was 1.58 days and the average of postoperative hospital stay was 8.56 days, and there was no death toll. In group B, the average prophylactic antibiotic use time was 5.36 days; there were 6 patients with nosocomial infection; the average therapeutic antibiotic use time was 5.86 days; the average ICU treatment time was 1.47 days and the average postoperative hospital stay was 8.87 days, and there was no death toll. Compared to group B, the preventive and therapeutic antibiotic use time in group A were significantly reduced（P 〈0.05）, but there was no statistical difference between the two groups in nosocomial infections rate, ICU treatment time and postoperative hospital stay. Conclusion The procalcitonin-guided antibiotics therapy after cardiac surgery can significantly reduce the treatment time, and has good feasibility, effectiveness and safety.