摘要
目的探讨降钙素原(PCT)水平指导重症加强护理病房(ICU)抗生素停用的临床价值。方法纳入2018年1月至2019年12月联勤保障部队第九○四医院收治的86例ICU重症感染患者为研究对象,依据患者的住院编号,使用随机数字表,将以上患者随机分为两组,其中对照组43例,实施常规抗生素治疗,按ICU重症感染的抗生素治疗原则选择及停用抗生素;观察组43例,实施PCT监测指导抗生素治疗,每日监测患者PCT水平,以PCT<0.25μg/L或PCT下降≥80%峰值水平且0.25μg/L≤PCT<0.50μg/L作为停用抗生素指征。观察两组抗生素使用时间及抗生素不良反应发生率,比较两组ICU住院时间、28 d感染复发率及28 d死亡率,并分析观察组存活者与死亡者血清PCT水平,采用受试者工作特征(ROC)曲线分析血清PCT水平对ICU重症感染患者短期死亡的预测价值。结果观察组抗生素使用时间显著短于对照组(P<0.05),观察组中停用抗生素比例为86.05%,显著低于对照组的51.16%(P<0.05)。观察组抗生素不良反应发生率为9.30%,显著低于对照组的25.58%(P<0.05)。观察组ICU住院时间较对照组比较差异无统计学意义(P>0.05)。观察组28 d感染复发率及28 d死亡率分别为4.65%、11.63%,对照组依次为6.98%、13.95%,差异无统计学意义(P>0.05)。观察组存活者血清PCT水平显著低于死亡者(P<0.05)。经ROC曲线分析,发现血清PCT水平对ICU重症感染患者短期死亡具有一定预测价值,曲线下面积为0.797。结论按照PCT水平停用ICU重症感染患者抗生素可缩短抗生素使用时间,降低抗生素不良反应发生率,且不影响患者短期复发率及死亡率,临床应引起足够重视。
Objective To explore the clinical value of procalcitonin(PCT)for the guidance of antibiotic withdrawal in the intensive care unit(ICU).Methods 86 patients with severe infection admitted to the ICU of the hospital from January 2018 to December 2019 were recruited as research subjects,and were divided into 2 groups according to the registry number.The 43 cases in the control group were given conventional antibiotic treatment,and antibiotics were selected and withdrawn according to the antibiotic treatment principles of ICU severe infection,while 43 patients in the observation group received antibiotic treatment guided by PCT monitoring.Monitoring of the PCT levels were performed daily,with the PCT level<0.25μg/L or the decreased PCT≥80%peak level and the 0.25μg/L≤PCT<0.50μg/L taken as the indicator of drug withdrawal.Observations were made on the duration of antibiotics use and rate of adverse reactions in the 2 groups.Length of stay in the ICU and the rate of 28-day infection recurrence rate,the rate of 28-day mortality were compared between the 2 groups.The PCT levels in the survivors and deaths of the observation group were analyzed.Finally,the value of serum PCT level was evaluated for the prediction of short-term death of ICU patients with severe infection by using the receiver-operating characteristic(ROC)curve.Results The length of antibiotics use in the observation group was significantly shorter than that in the control group(P<0.05),and the rate of antibiotics withdrawal in the observation group was 86.05%(37/43),which was significantly higher than that in the control group(51.16%)(22/43)(P<0.05).The rate of drug adverse reactions in the observation group was 9.30%,which significantly lower than 25.58%in the control group(P<0.05).There was no statistical significance in the length of stay in ICU,when comparisons were made between the observation group and the control group(P<0.05).The 28-day infection recurrence rate and the 28-day mortality rate in the observation group were respectively 4.65%and
作者
李娜
周华忠
华栋成
Li Na;Zhou Huazhong;Hua Dongcheng(No.94 Hospital,Joint Logistics Support Force,Chinese People′s Liberation Army,Changzhou 213003,China)
出处
《海军医学杂志》
2021年第4期456-460,共5页
Journal of Navy Medicine
