摘要
目的观察血必净和抗生素联合治疗对腹腔感染患者的效果及血清降钙素原(PCT)对抗生素使用的指导意义。方法选取抚顺市中心医院普通外科2013年3月~2016年3月收治的腹腔感染患者75例。根据随机数字表法将患者分成抗生素单纯治疗组(单纯治疗组,37例)及血必净和抗生素联合治疗组(联合治疗组,38例);同时单纯治疗组又随机分为抗生素对照组(18例)及抗生素PCT指导组(19例);联合治疗组又分为联合对照组(19例)及联合PCT指导组(19例)。所有患者根据基础病情及感染情况经验性应用抗生素,联合治疗组在常规治疗的基础上加用血必净注射液,抗生素PCT指导组和联合PCT指导组根据血清PCT水平调整抗生素的用量和时间,抗生素对照组和联合对照组根据患者的临床症状及血清其他炎性因子的水平调整用药。观察各组的PCT、C反应蛋白(CRP)、白细胞(WBC)水平及抗生素的平均使用时间。结果腹腔感染患者经过治疗后,血清炎性反应相关因子水平都有一定的下降。联合治疗组下降速度更快,其PCT从第3天开始明显低于相同时间点单纯治疗组(P<0.05),同时联合治疗组的CRP及WBC从第5天开始明显低于相同时间点单纯治疗组(P<0.05)。联合治疗组有效率(92.1%)明显高于单纯治疗组(67.6%),差异有统计学意义(P<0.05)。联合PCT指导组抗生素平均使用时间[(5.7±1.5)d]明显低于联合对照组[(9.5±1.8)d](P<0.05);抗生素PCT指导组抗生素平均使用时间明显低于抗生素对照组(P<0.05)。结论血必净联合抗生素治疗降低了腹腔感染患者PCT、CRP及WBC等炎症因子的水平,并且能改善抗生素对腹腔感染的治疗效果,根据PCT的变化确定停用抗生素的时间点,有利于减少抗生素的使用量。
Objective To investigate the effects of Xuebijing Injection combined with antibiotic on abdominal infection, procalcitonin （PCT） and its guiding significance on antibiotics using. Methods A total of 75 patients with severe abdominal infection hospitalized in Department of General Surgery, Fushun Central Hospital, from March 2013 to 2016 were selected. According to random number tablemethod, they were randomly divided into simple antibiotic treatment group （simple treatment group, 37 cases） and Xuebijing Injection combined with antibiotic group （combined group, 38 cases）, and simple treatment group were divided into antibiotic control group （18 cases） and antibiotic PCT guiding group （19 cases）, and the combined group were divided into combined control group （19 cases） and combined PCT guiding group （19 cases）. All patients were given empiric antibiotic therapy according to the basic and infection condition, the patients in combined group were administered with Xuebijing Injection, the patients in antibiotic PCT guiding group and combined PCT guiding group were adjusted the dose of antibiotics and time according to the serum PCT level, the patients in antibiotic control group and combined control group were adjusted the dose of antibiotics and time according to patients＂ clinical symptoms and serum levels of other inflammatory factor. The level PCT, CRP, WBC and the average time of antibiotics using were observed. Results After treatment, PCT, CRP, WBC of patients were significantly decreased, the decline of combined group was more obvious than antibiotic group. The PCT of combined group signifi- cantly was lower than the antibiotic group at the same time points started at the third day, the CRP and WBC of combined group significantly was lower than the antibiotic group at the same time started at the fifth day （P 〈 0.05）. The efficient in combined group （92,1%） was significantly higher than that in antibiotics group （67.6%）, the difference was statistically significant （P 〈 0.05）. The average time of antibiotics using in combined PCT guiding group [（5.7±1.5） d]was significantly lower than that in the combined control group [（9.5±1.8） d] （P 〈 0.05）; the average time of using antibiotics in antibiotic PCT guiding group significantly reduced compared with antibiotics control group （P 〈 0.05）. Conclusion Xuebijing Injection combined with antibiotic therapy reduces the PCT, CRP and WBC level of abdominal infection patients, it and can improve the effect of antibiotic treatment on abdominal infection. The time of discontinuation of antibiotics is determined according to the variation of PCT, it benefits minimizing the usage of antibiotics.
作者
杨光
YANG Guang(Department of General Surgery, Fushun Central Hospital, Liaoning Province, Fushun 113006, China)
出处
《中国医药导报》
CAS
2017年第5期125-128,152,共5页
China Medical Herald
关键词
血必净
抗生素
腹腔感染
降钙素原
Xuebijing Injection
Antibiotics
Abdominal infection
Procalcitonin
