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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2020, Vol. 13 ›› Issue (04) : 456 -460. doi: 10.3877/cma.j.issn.1674-6902.2020.04.005

论著

降钙素原监测在心脏围手术期抗感染中的临床应用
顾鹏1, 叶飞1, 陈劲进2, 彭晓波2, 胡雪莲1, 张蓉1,†()   
  1. 1. 400037　重庆，陆军（第三）军医大学第二附属医院药剂科
    2. 400037　重庆，陆军（第三）军医大学第二附属医院心外科
  • 收稿日期:2020-04-15 出版日期:2020-08-25
  • 通信作者: 张蓉
  • 基金资助:
    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)

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

Peng Gu1, Fei Ye1, Jinjin Chen2, Xiaobo Peng2, Xuelian Hu1, Rong Zhang1,†()   

  1. 1. Pharmaceutical Preparation Section, Xinqiao Hosptial, Army Medical University, Chongqing 400037, China
    2. Cardiac Surgery, Xinqiao Hosptial, Army Medical University, Chongqing 400037, China
  • Received:2020-04-15 Published:2020-08-25
  • Corresponding author: Rong Zhang
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引用本文：

顾鹏, 叶飞, 陈劲进, 彭晓波, 胡雪莲, 张蓉. 降钙素原监测在心脏围手术期抗感染中的临床应用[J]. 中华肺部疾病杂志(电子版), 2020, 13(04): 456-460.

Peng Gu, Fei Ye, Jinjin Chen, Xiaobo Peng, Xuelian Hu, Rong Zhang. Clinical application of procalcitonin monitoring during anti-infection in perioperative period of cardiac surgery[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(04): 456-460.

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。

关键词: 降钙素原, 围手术期, 抗菌药物, 肺部感染
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.

Key words: Procalcitonin, Perioperative period, Antibacterial drugs, Pulmonary infection
图1 120例患者术后各时间点炎性指标变化趋势图；注：D*表示术后第几天，如D1表示术后第一天；A：为白细胞计数；B：为中性粒细胞百分率；C：为PCT
表1 120例患者术后各时间点白细胞计数、中性粒细胞百分率、降钙素原变化情况比较
组　别 例数 白细胞计数(×109/L)，M(IQR) 中性粒细胞百分比(%) 降钙素原(ng/ml)
第1天 第3天 第7天 第1天 第3天 第7天 第1天 第3天 第7天
对照组 59 14.54(11.79～16.51) 11.19(9.16～13.79) 11.12(8.94～14.05) 89.40(87.50～91.60) 81.00(76.65～84.35) 73.75(70.80～77.20) 0.96(0.57～1.77) 0.39(0.20～0.61) 0.20(0.20～0.43)
实验组 61 14.70(12.44～19.81) 11.15(8.33～13.45) 10.97(8.67～13.28) 89.15(87.73～90.85) 79.50(76.18～84.90) 71.80(65.60～76.60) 0.90(0.48～2.15) 0.32(0.20～0.50) 0.20(0.20～0.43)
  Z值   1.12 -0.23 -0.51 -0.09 -0.52 -1.34 1.65 0.82 0.87
  P值   0.26 0.82 0.61 0.93 0.60 0.18 0.10 0.41 0.16
表2 试验组和对照组各结局指标比较
组　别 例数 肺部感染(n) 抗菌天数(d) 抗菌费用(千元) 住院天数(d) 总住院费用(万元)
对照组 59 2 12(9～15) 1.45(1.03～2.16) 19(17～23) 12.71(10.70～14.90)
实验组 61 2 9(7～12) 1.16(0.84～1.59) 18(15～22) 11.10(7.9～14.2)
  Z值     3.43 2.39 2.27 2.43
  P值   1.0 0.0006 0.02 0.02 0.02
1
Oussalah A, Ferrand J, Filhine-Tresarrieu P, et al. Diagnostic accuracy of procalcitonin for predicting blood culture results in patients with suspected bloodstream infection: An observational study of 35，343 consecutive patients (A STROBE-Compliant Article)[J]. Med, 2015, 94(44): e1774.
2
Nobre V, Borges I. Prognostic value of procalcitonin in hospitalized patients with lower respiratory tract infections[J]. Rev Bras Ter Intensiva, 2016, 28(2): 179-189.
3
Lubell Y, Blacksell SD, Dunachie S, et al. Performance of C-reactive protein and procalcitonin to distinguish viral from bacterial and malarial causes of fever in Southeast Asia[J]. BMC Infect Dis, 2015, 15(1): 511.
4
Smith KJ, Wateska A, Nowalk MP, et al. Cost-effectiveness of procalcitonin-guided antibiotic use in community acquired pneumonia[J]. J Gen Intern Med, 2013, 28(9): 1157-1164.
5
Michaelidis CI, Zimmerman RK, Nowalk MP, et al. Cost-effectiveness of procalcitonin-guided antibiotic therapy for outpatient management of acute respiratory tract infections in adults[J]. J Gen Intern Med, 2014, 29(4): 579-586.
6
Sager R, Kutz A, Mueller B, et al. Procalcitonin-guided diagnosis and antibiotic stewardship revisited[J]. BMC Med, 2017, 15(1): 15.
7
Giles D, Adriana LL, Oliver JB, et al. The role of serum procalcitonin in establishing the diagnosis and prognosis of pleural infection[J]. Respir Res, 2017, 18: 30.
8
Pontrelli G, Crescenzo FD, Buzzetti R, et al. Accuracy of serum procalcitonin for the diagnosis of sepsis in neonates and children with systemic inflammatory syndrome: a meta-analysis[J]. BMC Infect Dis, 2017, 17(1): 302.
9
Liu H, Luo Z, Liu L, et al. Early kinetics of procalcitonin in predicting surgical outcomes in type A aortic dissection patients[J]. 中华医学杂志(英文版), 2017, 130(10): 1175-1181.
10
侯喜琴，戴淑惠，黄朝阳，等. 降钙素原及CRP在外科感染早期诊断中的应用[J]. 中国实用医药，2010, 5(19): 35-36.
11
Schuetz P, Amin DN, Greenwald JL. Role of procalcitonin in managing adult patients with respiratory tract infections[J]. Chest, 2012, 141(4): 1063-1073.
12
Barton AK, Pelli A, Rieger M, et al. Procalcitonin as a biomarker in equine chronic pneumopathies[J]. BMC Vet Res, 2016, 12(1): 281.
13
Rhee C. Using Procalcitonin to guide antibiotic therapy[J]. Open Forum Infect Dis, 2017, 4(1): ofw249.
14
Dai X, Fu C, Wang C, et al. The impact of tracheotomy on levels of procalcitonin in patients without sepsis: a prospective study[J]. Clinics, 2015, 70(9): 612-617.
15
徐德钢. 降钙素原(PCT)监测在骨科内置物围手术期的临床应用研究[D]. 成都中医药大学，2012.
16
软正上，江　来. 降钙素原指导肠癌术后预防性抗菌药物应用的价值[J]. 实用医学杂志，2013, 29(4): 591-593.
17
Maekawa Y, Abe S, Yoshimura Y, et al. Procalcitonin as a marker of the postoperative infection in cardiovascular surgery[J]. KyobuGeka, 2014, 67: 519-525.
18
王　郝，崔　娜，牛　芳，等. 降钙素原对心脏外科术后重症患者感染的早期预测价值[J]. 中华危重病急救医学，2017, 29(10): 897-901.
19
Li X, Wang X, Li S, et al. Diagnostic value of procalcitonin on early postoperative infection after pediatric cardiac surgery[J]. Pediatr Crit Care Med, 2017, 18(5): 420.
20
Covington EW, Roberts MZ, Dong J. Procalcitonin monitoring as a guide for antimicrobial therapy: a review of current literature[J]. Pharmacotherapy, 2018, 38(5): 569-581.
21
Huetz P, Christ-Crain M, Thomann R, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial[J]. JAMA, 2009, 302: 1059-1066.
22
Bouadma L, Luyt CE, Tubach F, et al. Use of procalcitonin to reduce patients′exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial[J]. Lancet, 2010, 375(9713): 463-474.
23
Boussekey N, Leroy O, Alfandari S, et al. Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia[J]. Intensive Care Med, 2006, 32(3): 469-472.
24
Christcrain M, Opal SM. Clinical review: The role of biomarkers in the diagnosis and management of community-acquired pneumonia[J]. Crit Care, 2010, 14(1): 203.
25
Kondo Y, Umemura Y, Hayashida K, et al. Diagnostic value of procalcitonin and presepsin for sepsis in critically ill adult patients: a systematic review and meta-analysis[J]. J Intensive Care, 2019, 7: 22.
26
Huang DT, Yealy DM, Filbin MR, et al. Procalcitonin-guided use of antibiotics for lower respiratory tract infection[J]. N Engl J Med, 2018, 379(3): 236-249.
27
De Jong E, Van Oers JA, Beishuizen A, et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open label trial[J]. Lancet Infect Dis, 2016, 16(7): 819-827.
28
Patrick MH, David DB, Rachid A. Influence of pathogen and focus of infection on procalcitonin values in sepsis: are there additional confounding factors？[J]. Crit Care, 2019, 23(1): 215.
29
Yan ST, Sun LC, Jia HB, et al. Procalcitonin levels in bloodstream infections caused by different sources and species of bacteria[J]. Am J Emerg Med, 2017, 35(4): 579-583.
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