【摘要】 目的研究降钙素原(PCT)动态检测指标指导脑出血发热患者合理使用抗菌药物的价值。方法入选2013年5月~2015年4月湛江中心人民医院收治的240例脑出血伴发热患者,根据抽签法分为观察组和对照组,各120例;观察组患者需根据PCT动态值确定抗菌药的使用,对照组不参考PCT值,根据临床情况给予抗菌药治疗;记录观察组患者在不同时间点PCT水平情况,比较2组患者的菌群、抗菌药物使用、住院及转归情况。结果抗感染治疗后观察组患者在1、3、5、7、30 d的PCT水平显著低于治疗前[(18.23±2.01)μg/L、(14.34±1.87)μg/L、(7.24±1.12)μg/L、(3.43±0.34)μg/L、(0.87±0.04)μg/L比(25.04±2.32)μg/L],差异均有统计学意义(P<0.05)。2组患者的病原菌种类比较差异无统计学意义(P>0.05)。观察组患者的抗菌药物使用率显著低于对照组[56.67%(68/120)比86.67%(104/120)],使用时间显著短于对照组[(9.32±1.23)d比(13.38±1.31)d],使用费用显著少于对照组[(2 573.21±142.15)元比(4 632.15±264.77)元],差异均有统计学意义(P<0.05)。观察组患者的住院时间显著少于对照组[(9.89±1.54)d比(11.38±1.31)d],差异有统计学意义(P<0.05)。临床治愈率比较无统计学意义[90.0%(108/120)比86.67%(104/120)](P>0.05)。结论应用PCT动态监测指标指导脑出血发热患者使用抗菌药物,能减少抗菌药物的费用,降低抗菌药物的使用率,能在一定程度上避免抗菌药的过度使用,缓解了抗菌药带来的耐药压力。更多还原

【Abstract】 Objective To study the value of procalcitonin( PCT) dynamic detection guiding the rational use of antimicrobial agents in patients with cerebral hemorrhage fever. Methods 240 patients with cerebral hemorrhage and fever admitted in zhanjiang central people ’ s hospital from May 2013 to April 2015, according to the draw method the patients was divided into observation group and control group,120 patients in each group. The use of antimicrobials in the observation group based on PCT dynamic value,then the control group based on the clinical situation. Record the PCT levels in observation group at different time,and compare bacteria,antimicrobial drug use and the outcome,length of stay of the two groups. Results After anti-infection treatment for 1 d,3d,5 d,7 d,30 d,the PCT levels of patients in the observation group were significantly lower than before [( 18. 23± 2. 01) μg / L,( 14. 34 ± 1. 87) μg / L,( 7. 24 ± 1. 12) μg / L,( 3. 43 ± 0.34) μg / L,( 0.87 ± 0.04) μg / L VS( 25. 04± 2. 32) μg / L],these differences had statistical significance( P < 0.05). Bacteria of pathogenic had no statistical significance between two groups( P > 0.05). Antimicrobial drug use in observation group was less than the control group [56. 67%( 68 /120) VS 86. 67%( 104 /120) ],using time was shorter than the control group [( 9. 32 ±1. 23) d VS( 13. 38 ± 1. 31) d],the cost of drugs was less than the control group [( 2 573. 21 ± 142. 15) yuan VS( 4 632. 15 ± 264. 77) yuan],length of stay was less than the control group [( 9. 89 ± 1. 54) d VS( 11. 38 ±1. 31) d],and all the differences had statistical significance( P < 0.05). Clinical cure rate had no statistical significance between two groups [90.0%( 108 /120) VS 86. 67%( 104 /120) ]( P > 0.05). Conclusion PCT dynamic monitoring guiding patients with cerebral hemorrhage fever using antibacterial drugs can decrease the cost of the antibacterial drugs,reduce the usage of antibiotics,avoid the overuse of antimicrobials to some extent,relieve the pressure resistance of antimicrobials.更多还原