当代医学
噹代醫學
당대의학
CHINA CONTEMPORARY MEDICINE
2014年
4期
1-2
,共2页
重症急性胰腺炎%降钙素原%内毒素%感染%早期诊断
重癥急性胰腺炎%降鈣素原%內毒素%感染%早期診斷
중증급성이선염%강개소원%내독소%감염%조기진단
Severe acute pancreatitis%Procalcitonin%Endotoxin%Infection%Early diagnosis
目的：探讨降钙素原（PCT）和内毒素（PE）在重症急性胰腺炎（SAP）患者合并感染治疗中的临床意义。方法选择2011年5月-2013年5月收治入院的86例SAP患者，随机分为两组，PCT或内毒素指导组（病例组43例）和预防性抗生素治疗组（对照组43例）。每天监测两组患者血清PCT、内毒素水平，PCT临界值为0.5μg/L，内毒素为0.01 EU/ml，病例组当临床感染的体征和症状出现且PCT>0.5μg/L或内毒素升高达＞0.01 EU/ml时开始抗生素治疗，当临床症状和体征的改善且PCT下降到<0.5μg/L或内毒素下降达<0.01 EU/ml时超过3d停用抗生素。在对照组抗生素治疗预防给药2周，如果临床感染的体征和症状仍存在，继续抗生素治疗直到感染的临床症状和体征消失3d，比较两组患者抗生素治疗时间、住院时间、并发症、生存率、住院费用等指标，并进行统计学分析。结果病例组并发症发生率明显少于对照组，生存率明显高于对照组，且比较差异有统计学意义（P＜0.05）；病例组抗生素治疗时间，住院时间均较对照组抗生素组短，两组比较差异有统计学意义（P<0.01），病例组住院费用也明显低于对照组（P<0.01）。结论监测PCT、内毒素指导SAP患者合并感染治疗中是有用的指标，有利于减少抗生素的使用时间，减少细菌耐药和缩短住院时间并降低住院费用。
目的：探討降鈣素原（PCT）和內毒素（PE）在重癥急性胰腺炎（SAP）患者閤併感染治療中的臨床意義。方法選擇2011年5月-2013年5月收治入院的86例SAP患者，隨機分為兩組，PCT或內毒素指導組（病例組43例）和預防性抗生素治療組（對照組43例）。每天鑑測兩組患者血清PCT、內毒素水平，PCT臨界值為0.5μg/L，內毒素為0.01 EU/ml，病例組噹臨床感染的體徵和癥狀齣現且PCT>0.5μg/L或內毒素升高達＞0.01 EU/ml時開始抗生素治療，噹臨床癥狀和體徵的改善且PCT下降到<0.5μg/L或內毒素下降達<0.01 EU/ml時超過3d停用抗生素。在對照組抗生素治療預防給藥2週，如果臨床感染的體徵和癥狀仍存在，繼續抗生素治療直到感染的臨床癥狀和體徵消失3d，比較兩組患者抗生素治療時間、住院時間、併髮癥、生存率、住院費用等指標，併進行統計學分析。結果病例組併髮癥髮生率明顯少于對照組，生存率明顯高于對照組，且比較差異有統計學意義（P＜0.05）；病例組抗生素治療時間，住院時間均較對照組抗生素組短，兩組比較差異有統計學意義（P<0.01），病例組住院費用也明顯低于對照組（P<0.01）。結論鑑測PCT、內毒素指導SAP患者閤併感染治療中是有用的指標，有利于減少抗生素的使用時間，減少細菌耐藥和縮短住院時間併降低住院費用。
목적：탐토강개소원（PCT）화내독소（PE）재중증급성이선염（SAP）환자합병감염치료중적림상의의。방법선택2011년5월-2013년5월수치입원적86례SAP환자，수궤분위량조，PCT혹내독소지도조（병례조43례）화예방성항생소치료조（대조조43례）。매천감측량조환자혈청PCT、내독소수평，PCT림계치위0.5μg/L，내독소위0.01 EU/ml，병례조당림상감염적체정화증상출현차PCT>0.5μg/L혹내독소승고체＞0.01 EU/ml시개시항생소치료，당림상증상화체정적개선차PCT하강도<0.5μg/L혹내독소하강체<0.01 EU/ml시초과3d정용항생소。재대조조항생소치료예방급약2주，여과림상감염적체정화증상잉존재，계속항생소치료직도감염적림상증상화체정소실3d，비교량조환자항생소치료시간、주원시간、병발증、생존솔、주원비용등지표，병진행통계학분석。결과병례조병발증발생솔명현소우대조조，생존솔명현고우대조조，차비교차이유통계학의의（P＜0.05）；병례조항생소치료시간，주원시간균교대조조항생소조단，량조비교차이유통계학의의（P<0.01），병례조주원비용야명현저우대조조（P<0.01）。결론감측PCT、내독소지도SAP환자합병감염치료중시유용적지표，유리우감소항생소적사용시간，감소세균내약화축단주원시간병강저주원비용。
Objective To investigate the procalcitonin (PCT) and endotoxin (PE) in patients with severe acute pancreatitis (SAP) in patients co-infected treatment clinical significance. Methods 86 patients with SAP were randomly assigned to one or endotoxins PCT steering group and prophylactic antibiotic treatment groups. Serum PCT, endotoxin levels were monitored daily, PCT threshold of 0.5μg/L, endotoxin is 0.01 EU/ml, the case group when the clinical signs and symptoms of infection and PCT>0.5μg/L or endotoxin increased up to>0.01 EU/ml start antibiotic treatment, when the clinical signs and symptoms improved and PCT decreased to<0.5μg/L or endotoxins fell by<0.01 EU/ml disabled when more than three days of antibiotics. The control group treated with antibiotics prophylaxis for two weeks, if the clinical signs and symptoms of infection still exist and continue to antibiotic treatment until clinical signs and symptoms of infection disappeared three days, the days treated with antibiotics time, hospital stay, complications, and survival rates, hospital costs and other indicators were observed, and analyzed statistically. Results The incidence of complications in case group was significantly lower than the control group, the survival rate was significantly higher than control group, and the difference was statistically significant (P<0.05);antibiotic treatment time, the number of hospitalization days in case group were shorter than those in the control group, the difference was statistically significant (P<0.01),hospitalization costs in case group was significantly lower than that in the control group (P<0.01). Conclusion Monitoring PCT, endotoxin guiding patients with SAP treatment of infection are useful indicators, helps to reduce the use of antibiotics time, reduce bacterial resistance and shorter hospital stays and lower hospital costs.
