降钙素原在儿童社区获得性肺炎使用抗生素中的应用价值

Application value of procalcitonin to use antibiotics in children with community acquired pneumonia

目的探讨降钙素原(PCT)在儿童社区获得性肺炎(CAP)使用抗生素中的应用价值。方法选取收入住院治疗的儿童CAP 84例,采用随机数字表法把患儿分为观察组和对照组各42例。观察组依据PCT的浓度使用抗生素;对照组依据《抗菌药物临床应用指导原则(2015年版)》,和经验使用抗生素。统计两组的抗生素使用情况,抗生素处方使用率、治疗后情况、住院时间、住院费用和疗效。采用卡方检验和t检验分析数据。结果观察组使用抗生素构成比、抗生素使用天数、两种抗生素联合构成比、抗生素不良反应构成比、抗生素费用、住院时间和住院费用均明显少于对照组(P<0.05);在治疗第1、3、5天时,观察组的抗生素处方使用率均明显低于对照组(P<0.05)。在观察组中,治疗第5天后的抗生素处方使用率出现明显下降,而在对照组中是治疗后第7天;两组疗效和临床症状消失时间的差异均没有统计学意义(P>0.05)。结论以PCT指导儿童CAP抗生素使用的策略既不影响疗效,又可以有效减少抗生素使用率、抗生素不良反应、抗生素费用、抗生素疗程、住院时间和住院总费用。

Objective To investigate the value of procalcitonin （PCT） to use antibiotics in children with community acquired pneumonia （CAP）. Methods 84 children with CAP were included. The patients were divided into observation group （42 cases） and control group （42 cases） by random number table method. The observation group was based on the concentration of PCT to determine whether the use antibiotics. Control group was according to the Guiding Principles for Clinical Application of Antimicrobial Agents （2015 version） and clinical experience to use antibiotics. Data was collected on the situation of antibiotics use, antibiotic prescription usage rate, situation of after treatment, length of stay, cost of hospitalization and curative effect. Results The constituent ratio of the use of antibiotics, antibiotic use days, constituent ratio of combined use of two antibiotics, constituent ratio of adverse antibiotics reaction, antibiotic cost, length of stay and cost of hospitalization in the observation group were significantly less than those in the control group （P〈0.05）. In the treatment of first, third, fifth days, the antibiotic prescription usage rate in the observation group was significantly lower than that in the control group （P〈0.05）. In the observation group, the fifth days after treatment, the use rate of antibiotics was significantly decreased, while in the control group was seventh days after treatment. There was no significant difference in the curative effect and disappearance time of clinical symptoms between the two groups （P〉0.05）. Conclusions The strategy of using PCT to guide use antibiotics in children with CAP not only does not affect the efficacy, but also can effectively reduce the use of antibiotics, adverse antibiotics reaction, antibiotic cost, course of antibiotics usage, length of stay and cost of hospitalization.