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《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2020年04期

页码:

456-460

栏目:

论著

出版日期:

2020-08-20

文章信息/Info

Title:

Clinical application of procalcitonin monitoring during anti-infection in perioperative period of cardiac surgery

作者:

顾 鹏¹ 叶 飞¹ 陈劲进² 彭晓波² 胡雪莲¹ 张 蓉¹

400037 重庆,陆军(第三)军医大学第二附属医院药剂科¹、心外科²

Author(s):

Gu Peng¹;  Ye Fei¹;  Chen Jinjin²;  Peng Xiaobo²;  Hu Xuelian¹;  Zhang Rong¹.

¹Pharmaceutical Preparation Section, Xinqiao Hosptial, Army Medical University, Chongqing 400037, China; ²Cardiac Surgery, Xinqiao Hosptial, Army Medical University, Chongqing 400037, China
Corresponding author

关键词:

降钙素原;  围手术期;  抗菌药物;  肺部感染

Keywords:

Procalcitonin;  Perioperative period;  Antibacterial drugs;  Pulmonary infection

分类号:

R734

DOI:

10.3877/cma.j.issn.1674-6902.2020.04.005

摘要:

目的 探讨降钙素原(PCT)监测在缩短心脏手术抗菌药物疗程的有效性及安全性,以期为临床合理使用抗菌药物提供参考。方法 采用随机对照试验(RCT)设计,纳入心脏手术患者共计120例,使用随机数字表法将患者分为试验组(降钙素原监测组)与对照组(常规方法监测组)。其中试验组共61例,对照组共59例。试验组以降钙素原指导抗菌药物使用,对照组以常规方法指导抗菌药物使用。比较这两组患者抗菌药物使用时间、住院天数、抗菌药物费用、住院费用及肺部感染发生率等指标。结果 所有患者术后均预防性使用抗菌药物,第1、3、7天白细胞、中性粒细胞百分率、降钙素原水平逐渐下降,其中白细胞、降钙素原前3天显著下降,而中性粒细胞呈持续下降趋势; 两组患者降钙素原术后第3天恢复至接近正常水平,第7天完全恢复至正常水平,中性粒细胞百分比第7天恢复正常。两组各时间点白细胞、中性粒细胞百分率、降钙素原水平无统计学差异(P>0.05)。试验组与对照组抗菌药物使用时间分别为9 d和12 d、住院天数分别为18 d和19 d、抗菌药物费用分别为1.16千元和1.45千元、总住院费用分别为11.10万元和12.71万元。P值均<0.05,差异有统计学意义。试验组和对照组分别有两例患者发生肺部感染,无统计学差异(P>0.05)。结论 对于心脏手术,依据降钙素原水平指导抗菌药物的预防使用,可缩短抗菌药物疗程、减少患者住院天数并节约抗菌药物费用和住院费用并且不增加肺部感染发生率。

Abstract:

Objective To explore the efficacy and safety of procalcitonin(PCT)in shortening the course of antimicrobial agents in cardiac surgery so as to provide references for the rational use of antimicrobial agents in the clinical practice. Methods A randomized controlled trial(RCT)was designed and 120 patients were included in this study. The patients were randomly divided into an experimental group(the PCT monitoring group)and a control group(the routine monitoring group)by the random number method. In the experimental group, PCT was employed to guide the use of antimicrobial agents; while in the control group, routine methods were employed to guide the use of antimicrobial agents. The consumption time of antibacterial agents, the hospitalization time, the costs for antibacterial drugs, the total hospitalization costs, and the incidence of pulmonary infection were compared between the two groups. Results The antimicrobial agents were used in both the experimental group and the control group after operation. The levels of white blood cells, neutrophils and PCT decreased gradually on the 1 st, 3 rd and 7 th days. The PCT decreased to the normal level on the 3 rd day, while the percentage of neutrophils recovered to normal on the 7 th day. There was no significant difference in white blood cells, neutrophil percentages and PCT levels between the two groups at all the time points(P>0.05). However, statistical differences were found in the consumption time of antibacterial drugs, the costs for antibacterial drugs, the hospitalization time, and the hospitalization costs between the two groups. The consumption time of antibacterial drugs in the control group was 12 days, while it was 9 days in the experimental group, with a statistical significant difference between the two groups(P<0.05). The hospitalization time in the control group was 19 days, while it was 18 days in the experimental group, with a statistical significant difference between the two groups(P<0.05). The cost of the antibacterial drugs in the control group was 1, 450 yuan, while it was 1,160 yuan in the experimental group, with a statistical significant difference between the two groups(P<0.05). The hospitalization cost in the control group was 127,100 yuan, while it was 111,000 yuan in the experimental group, with a statistical significant difference between the two groups(P<0.05). Two patients in the experimental group and two patients in the control group developed pulmonary infection, with no significant difference between the two groups(P>0.05). Conclusion For cardiac surgery, the prophylactic use of antibiotics guided by PCT monitoring can shorten the course of antibiotics, reduce the length of hospital stay, and save the costs of antibiotics and hospitalization. Furthermore, it does not increase the incidence of pulmonary infection.

参考文献/References:

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备注/Memo

备注/Memo:

基金项目: 重庆市自然科学基金资助项目(cstc2018jcyjAX0183) 陆军军医大学第二附属医院临床科研项目(2014YCL35)
通信作者: 张 蓉, Email: zrcq73@163.com

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更新日期/Last Update: 2020-08-20