连续监测降钙素原对细菌性肺炎患儿合理使用抗菌药物的影响

Effect of Continuous Monitoring of Procalcitonin on Rational Use of Antibiotics in Children with Bacterial Pneumonia

目的:探讨连续监测降钙素原(procalcitonin,PCT)对细菌性肺炎(Bacterial pneumonia,BP)患儿合理使用抗菌药物的影响。方法:以随机数字表法将2020年5月—2021年12月婺源县人民医院和婺源县妇幼保健院收治的110例BP患儿为研究对象,随机分为对照组和观察组,每组55例。对照组参考临床指导标准对患儿进行经验性的抗菌药物的治疗,观察组则通过制定指导抗菌药物使用的PCT临界值范围,依据患儿PCT水平指导抗菌药物使用方案。比较两组抗菌药物使用情况、临床疗效、住院情况、血清指标(WBC、CRP、SAA)及不良反应发生率。结果:观察组抗菌药物使用例数、双联抗菌药物使用率、抗菌药物使用时间、抗菌药物费用均低于对照组(P<0.05);观察组退热时间、住院时间以及住院费用均低于对照组(P<0.05),但两组气管插管率比较,差异无统计学意义(P>0.05);两组治疗后WBC、CRP、SAA水平低于治疗前,且观察组低于对照组(P<0.05);观察组不良发应发生率低于对照组(P<0.05)。结论:采用连续监测PCT水平在BP患儿抗菌药物的合理使用方面具有积极意义,能有效降低抗菌药物的使用率,缩短治疗时间并减少患儿医疗费用和住院时间,同时也能有效提高临床疗效,改善患儿预后。

Objective:To investigate the effect of continuous monitoring of procalcitonin(PCT)on rational use of antibiotics in children with Bacterial pneumonia(BP).Methods:A total of 110 children with BP admitted to Wuyuan County People’s Hospital and Wuyuan County Maternal and Child Health Hospital from May 2020 to December 2021 were randomly divided into control group and observation group,with 55 children in each group.The control group was treated with empirical antibiotics according to the clinical guidelines,while the observation group was guided by the PCT critical value range to guide the use of antibiotics,and the antimicrobial use program was guided according to the PCT level of the children.The use of antibiotics,clinical efficacy,hospitalization,serum indexes(WBC,CRP,SAA)and incidence of adverse reactions were compared between the two groups.Results:The number of cases of antibiotics,the utilization rate of dual antibiotics,the use time of antibiotics and the cost of antibiotics in observation group were lower than those in control group(P<0.05).The time of fever reduction,hospital stay and hospital expenses in the observation group were lower than those in the control group(P<0.05),but there was no statistical significance in the rate of tracheal intubation between the two groups(P>0.05).The levels of WBC,CRP and SAA after treatment were lower than before treatment,and observation group was lower than control group(P<0.05).The incidence of adverse events in observation group was lower than that in control group(P<0.05).Conclusion:Continuous monitoring of PCT level has positive significance in the rational use of antibiotics in children with BP,which can effectively reduce the utilization rate of antibiotics,shorten the treatment time and reduce the medical cost and hospital stay of children,and also effectively improve the clinical efficacy and prognosis of children.