降钙素原指导全身炎症反应综合征导致的多器官功能障碍综合征的抗生素应用

The guidance of procalcitonin for antibiotic’s application in treatment of SIRS caused MODS

目的：探讨降钙素原（ PCT ）指导全身炎症反应综合征（ SIRS ）导致的多器官功能障碍综合征（ MODS）的抗生素的应用。方法选取2014年7月至2015年10月严重脓毒症导致的MODS患者42例，按随机数字表法分为对照组（不监测PCT的21例）和实验组（监测PCT的21例）。对照组给予脓毒症基础治疗，实验组在对照组的基础上隔日监测PCT。结果两组治疗前APACHEⅡ评分比较差异均未见统计学意义；治疗后3、7 d与治疗前比较均明显降低，且治疗7d时实验组抗生素应用时间与对照组比较下降更显著。两组治疗前细菌感染程度评分、体温、血糖、C-反应蛋白、白细胞计数水平比较差异未见统计学意义，实验组治疗后上述指标的改善程度均明显优于对照组，以治疗3d时改善最显著。两组各时间点白细胞计数水平比较差异均未见统计学意义。结论降钙素原在ICU中监测SIRS导致的MODS的抗生素应用中具有减少抗生素耐药、降低抗生素使用率等临床意义。

Objective To investigate the clinical research of procalcitonin to monitoring antibiot-ic in treatment of SIRS caused MODS. Methods 42 cases of severe sepsis caused MODS patients treated from July,2014 to October,2015 were chosen,and they were divide into control group（21 cases with no PCT monitoring）and observation group（21 cases with PCT monitoring）. The control group was applied with Basic sepsis treatment,while the observation group received PCT monitoring every other day besides the basic treatment as control group. Results Before treatment,the difference of APACHE Ⅱscore be-tween the two groups had no statistical significance. After treatment for 3 d and 7 d,the score reduced ob-viously,and after 7 d,the reduction of antibiotic application time in observation group was more obvious than that in control group. Before treatment,the comparison of the degree of bacterial infection,body tem-perature,blood sugar,CRP,and WBC level between the two groups had no statistical significance. But af-ter treatment,the improvement of those indicators in observation group was obviously better than control group,and the improvement was more notable 3 d after treatment. The comparison of WBC level at each time point between the two groups had no statistical significance. Conclusions Appling procalcitonin to monitoring the application of antibiotic in treatment of SIRS caused MODS has clinical significance,which can reduce antibiotic resistance and decrease the use of antibiotics.