动态监测降钙素原对重症社区获得性肺炎患儿抗感染治疗的临床研究

刘瑶; 吴金桓; 范铭兴; 陈俊; 赵劭懂; 缪红军

doi:10.16766/j.cnki.issn.1674-4152.002841

动态监测降钙素原对重症社区获得性肺炎患儿抗感染治疗的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.002841

1.
南京医科大学附属儿童医院药学部，江苏南京 210008
2.
南京医科大学附属儿童医院急诊重症医学科

基金项目:

江苏省自然科学基金青年基金项目 BK20170147

江苏省药学会奥赛康医院药学科研基金项目 A202218

详细信息

通讯作者:
缪红军，E-mail：jun848@126.com

中图分类号: R725.6 R563.1
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出版历程
- 收稿日期: 2022-11-21
- 网络出版日期: 2023-04-20

Clinical study of dynamic monitoring of serum procalcitonin for anti-infection treatment in children with severe community acquired pneumonia

1.
Department of Pharmacy, Children ' s Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China

摘要

摘要: 目的评估动态监测血清降钙素原对儿童重症社区获得性肺炎抗感染治疗方案的指导意义和应用价值。方法选取2019年1月—2022年6月在南京医科大学附属儿童医院重症医学科治疗的重症社区获得性肺炎患儿共150例，根据是否进行血清降钙素原动态监测分为观察组65例和对照组85例。对照组采用常规抗菌药物治疗方案，观察组结合PCT动态监测结果调整用药方案。比较2组患儿抗菌药物使用率、使用疗程、累计抗菌药物消耗数、药物选择、退热时间、ICU滞留时间、出院转归等。结果对照组人均累计抗菌药物消耗数为3.50(1.92, 6.20)，而观察组明显低于对照组，仅为2.13(1.25，4.95)，P < 0.05；观察组的抗菌药物疗程较对照组约缩短1 d[7.0(5.0，10.0)d vs. 8.0(5.0，11.0) d，P < 0.05]；对照组的抗菌药物总费用为1 659.0(1 036.3，3 263.2)元, 显著高于观察组[762.2(243.3, 1 423.8)元，P < 0.01]；观察组的特殊级抗菌药物使用率低于对照组[27.3%(18/66) vs. 51.8%(44/85)，P < 0.01]。观察组退热时间、ICU滞留时间、出院转归与对照组比较差异无统计学意义(均P>0.05)。结论动态监测降钙素原有助于重症社区获得性肺炎患儿抗菌药物合理使用，尤其对于特殊级抗菌药物的使用、降级和停用具有指导意义。
- 降钙素原 /
- 重症社区获得性肺炎 /
- 儿童 /
- 抗感染
Abstract: Objective To explore the guiding significance and application value of dynamic monitoring of serum procalcitonin for anti-infection therapy in children with severe community acquired pneumonia. Methods A total of 150 children with severe community acquired pneumonia treated in Nanjing Children ' s Hospital from January 2019 to June 2022 were enrolled. They were assigned into observation group (65 cases) and control group (85 cases) according to whether dynamic procalcitonin monitoring was performed. The control group was treated with conventional antibacterial drugs, while the observation group was adjusted with the results of PCT dynamic monitoring. The use rate of antibiotics, the course of use, the cumulative consumption of antibiotics, the choice of drugs, the duration of fever, the time of ICU stay, and the outcome of discharge were compared between the two groups. Results The cumulative consumption of antibacterial drugs per capita in the control group was 3.50 (1.92, 6.20), while it was significantly lower than that in the observation group [2.13 (1.25, 4.95), P < 0.05]. The duration of antimicrobial treatment in the observation group was about 1 day shorter than that in the control group [7.0 (5.0, 10.0) days vs. 8.0 (5.0, 11.0) days, P < 0.05]. The total cost of antimicrobial drugs in the control group was 1 659.0 (1 036.3, 3 263.2) yuan, which was significantly higher than that in the observation group [762.2 (243.3, 1 423.8) yuan, P < 0.01]. The use rate of special grade antibiotics in the observation group was lower than that in the control group [27.3% (18/66) vs. 51.8% (44/85), P < 0.01]. There was no difference in the duration of fever, the time of ICU stay, the outcome of discharge between the two groups (P>0.05). Conclusion Dynamic monitoring of serum PCT is helpful to the rational use of antibiotics in children with severe community-acquired pneumonia, especially for the use, degradation and discontinuation of special grade antibiotics.
- Serum procalcitonin /
- Severe community acquired pneumonia /
- Children /
- Anti-infection

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图 1 动态监测PCT指导抗菌药物使用流程

Figure 1. Dynamic monitoring of PCTS guides the process of antibiotic use

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表 1 2组重症肺炎患儿一般资料比较

Table 1. Comparison of general data between two groups of children with severe pneumonia

组别	例数	性别[例(%)]		年龄 [M(P₂₅, P₇₅), 月龄]	体重 [M(P₂₅, P₇₅)，kg]	未使用通气[例(%)]	未发生胸腔积液[例(%)]
组别	例数	男	女	年龄 [M(P₂₅, P₇₅), 月龄]	体重 [M(P₂₅, P₇₅)，kg]	未使用通气[例(%)]	未发生胸腔积液[例(%)]
对照组	85	53(62.4)	32(37.6)	30.2(4.7, 65.3)	12.0(7.9, 19.5)	78(91.8)	67(78.8)
观察组	65	37(56.1)	28(43.1)	24.5(8.2, 56.6)	12.7(8.1, 16.0)	53(80.3)	57(86.4)
统计量		0.452^a		0.432^b	0.173^b	4.412^a	1.341^a
P值		0.614		0.665	0.863	0.063	0.345

组别	例数	入科前未使用抗菌药物[例(%))	入科体温 (x±s, ℃)	入科心率 (x±s, 次/min)	入科呼吸频率 (x±s, 次/min)	首次监测CRP [M(P₂₅, P₇₅), mg/L]	首次监测WBC [M(P₂₅, P₇₅), ×10⁹/L]
对照组	85	7(8.24)	37.4±0.8	142.8±26.2	36.7±10.8	8.0(8.0, 24.0)	10.3(7.4, 14.6)
观察组	65	12(18.5)	37.5±1.0	146.9±32.7	36.7±11.1	8.0(1.3, 18.1)	10.9(7.4, 14.8)
统计量		3.482^a	0.577^c	0.842^c	0.016^c	0.902^b	0.250^b
P值		0.106	0.580	0.401	0.987	0.367	0.802
注：^a为χ²值，^b为Z值，^c为t值。

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表 2 2组重症肺炎患儿临床疗效评价指标比较

Table 2. Comparison of clinical efficacy evaluation indexes in two groups of children with severe pneumonia

组别	例数	出院转归[例(%)]		退热时间 [M(P₂₅, P₇₅)，h]	总住院时间 [M(P₂₅, P₇₅)，d]	ICU滞留时间 [M(P₂₅, P₇₅)，d]
组别	例数	好转	治愈	退热时间 [M(P₂₅, P₇₅)，h]	总住院时间 [M(P₂₅, P₇₅)，d]	ICU滞留时间 [M(P₂₅, P₇₅)，d]
对照组	85	84(98.8)	1(1.2)	36.0(12.0, 120.0)	14.0(10.0, 17.0)	8.0(5.0, 12.0)
观察组	65	64(98.5)	1(1.5)	24.0(12.0, 72.0)	12.0(9.0, 17.0)	7.0(5.0, 11.0)
统计量		0.037^a		0.773^b	0.566^b	0.554^b
P值		0.848		0.439	0.173	0.579
注：^a为χ²值，^b为Z值。

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表 3 2组重症肺炎患儿抗菌药物使用相关指标比较

Table 3. Comparison of indexes related to the use of antibiotics in two groups of children with severe pneumonia

组别	例数	抗菌药物使用率[例(%)]	高度怀疑细菌感染例[例(%)]	使用特殊级抗菌药物[例(%)]	人均DDDs [M(P₂₅, P₇₅)]	单位体重DDDs [M(P₂₅, P₇₅)]	抗菌药物疗程 [M(P₂₅, P₇₅)，d]	抗菌药物费用 [M(P₂₅, P₇₅)，元]	抗菌药物日均费用 [M(P₂₅, P₇₅)，元/d]
对照组	85	84(98.8)	44(51.8)	44(51.8)	3.50(1.92, 6.20)	0.29(0.19, 0.47)	8.0(5.0, 11.0)	1 659.0(1 036.3, 3 263.2)	208.5(128.9, 365.8)
观察组	65	60(92.3)	40(60.6)	18(27.3)	2.13(1.25, 4.95)	0.23(0.10, 0.38)	7.0(5.0, 10.0)	762.2(243.3, 1 423.8)	95.1(22.8, 200.0)
统计量		4.072^a	1.011^a	8.802^a	2.477^b	2.454^b	1.341^b	5.027^b	5.270^b
P值		0.085	0.401	0.005	0.013	0.063	0.014	< 0.001	< 0.001
注：^a为χ²值，^b为Z值。

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