降钙素原指导蛇咬伤患者抗菌药物的临床应用

Increased serum Procalcitonin levels as an index of antibiotics usage in snake-bite patients

目的观察降钙素原(procalcitonin,PCT)指导蛇咬伤患者应用抗菌药物的临床价值。方法回顾性分析2015年1月—12月重庆市急救医疗中心收治的414例蛇咬伤患者在传统标准(A组)和PCT指导下(B组)使用抗菌药物的临床效果,其中A组197例,男性124例,女性73例;平均年龄42.12岁;B组217例,男性152例,女性65例;平均年龄44.43岁。分析两组患者住院天数、使用抗菌药物比例、抗菌药物使用天数、住院费用及患者在脓肿、局部组织坏死、脓毒症、截肢及死亡的发生率差等各项数据。结果 PCT组(B组)的蛇咬伤患者住院时间(5.74±1.94)d、使用抗菌药物112例(51.61%)、使用抗菌药物时间(4.14±1.01)d、住院费用(4192.18±2119.68)元,显著低于传统标准组(A组)的(6.32±2.77)d、132(67.01%)、(4.55±1.65)d、(4755.23±2579.31)元,差异有统计学意义(P<0.05)。两组患者在肢体脓肿、局部组织坏死、脓毒症、截肢及死亡的发生率方面差异均无统计学意义(P<0.05)。结论蛇咬伤患者降钙素原指导抗菌药物使用,既能有效控制感染,又能减少抗菌药物的使用率及使用天数。

Objective To investigate the role of increased serum Procalcitonin（PCT） levels on treatment of snake-bite patients with antibiotics. Methods Totally 414 snake-bite patients admitted in Chongqing Emergency Medical Center from Jan. 2015 to Dec. 2015 were retrospectively analyzed. Totally 197 patients（group A,124 males and 73 females with an average age of 42. 12 years） used antibiotics under the instruction of common indicators such as white blood cell count,C-reactive protein（CRP） and body temperature,while the other 217 cases（group B,152 males and 65 females with an average age of 44. 43 years） used antibiotics under the guidance of increased serum Procalcitonin levels. The hospitalized days,the antibiotic usage rate,the antibiotic usage days,hospitalization costs,the rates of the abscess,tissue necrosis,and sepsis were observed between the two groups. Results Compared to group A,the hospitalized days（（5. 74 ± 1. 94） d vs.（6. 32 ± 2. 77） d; P 〈0. 05）,the antibiotic usage rate（51. 61% vs.67. 01%,P 〈0. 05）,the antibiotic usage days（（4. 14 ± 1. 01） d vs.（4. 55 ± 1. 65） d; P〈 0. 05） and hospitalization costs（（4192. 18 ± 2119. 68） yuan vs.（4755. 23 ± 2579. 31） yuan; P 〈0. 05） were significantly decreased in group B. The rates of the abscess,tissue necrosis,and sepsis had no statistical difference between the two groups（P 〉0. 05）. Conclusion Procalcitonin can be used as an indicator to guide the use of antimicrobial drugs for snake bites patients,which can effectively control infection,and reduce the usage of antibacterial drugs.