动态降钙素原监测指导ICU脓毒症患者抗菌药物使用及其临床价值分析

Dynamic procalcitonin monitoring guiding antimicrobial drug use on ICU patients with sepsis and analysis of its clinical value

目的探讨对入住重症监护病房(ICU)的脓毒症患者,进行动态降钙素原(PCT)监测的临床意义及其在指导抗菌药物应用方面的价值。方法对本院ICU 2012年5月-2014年5月收治的98例脓毒症患者的治疗过程进行回顾性分析,根据是否进行动态PCT监测分为PCT组和常规组,通过对2组相关指标进行比较;并根据患者转归对PCT组进行分析,探讨PCT监测的临床意义。结果 2组患者均使用了抗菌药物治疗,PCT组抗菌药物使用时间(8.4±2.4)d、ICU住院时间(10.3±2.7)d、费用(15 087.9±4 154.8)元均显著低于常规组,差异有统计学意义(P<0.05)。对PCT组分析发现,第1 d、3 d、5 d、7 d、9 d存活组APACHEⅡ评分、SOFA评分及PCT值均显著低于死亡组,差异有统计学意义(P<0.05),且均随着治疗时间的延长逐渐降低,死亡组则逐渐升高。结论对ICU脓毒症患者进行PCT动态监测,能够指导临床合理应用抗菌药物,同时PCT监测可对患者的预后情况进行判断。

Objective To discuss the clinical significance and its value in guiding antibiotics use of dynamic procalcitonin（ PCT） surveillance on intensive care unit（ ICU） patients with sepsis. Methods The 98 treated patients with sepsis were retrospectively analyzed,who were hospitalized in ICU during May 2012- May 2014 in our hospital. And according to whether performing dynamic monitoring of PCT,the sepsis patients were divided into the PCT group and the conventional group; through the comparison of related indicators in the two groups,and according to the patient＇s prognosis,the PCT group was analyzed,in order to discuss the clinical significance of PCT monitoring. Results Two groups of patients accepted antibiotic therapy,the use time of antimicrobial agents was（ 8. 4 ± 2. 4） d,the stay length in ICU was（ 10. 3 ± 2. 7） d,the cost was（ 15 087. 9 ± 4 154. 8）Yuan,which were significantly lower than the conventional group patients,with the difference statistically significant（ P 〈0. 05）. Through the analysis on the PCT group,the APACHE Ⅱ score,sofa score and PCT values of the survival group at 1 d,3 d,5 d,7 d,9 d were significantly lower than those in death group,with the difference statistically significant（ P 〈0. 05）,and all decreased with the treatment time,however,the death group increased gradually. Conclusion ICU patients with sepsis were conducted for PCT dynamic monitoring,which can guide the rational use of antimicrobial drugs,while PCT can monitor the patient＇s prognosis judge.