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投稿时间：2025-03-06 网络发布日期：2025-11-26
投稿时间：2025-03-06 网络发布日期：2025-11-26
中文摘要: 目的 探讨动态监测脓毒症患者血浆降钙素原（PCT）水平指导抗生素治疗对疗程及耐药性的影响，评价其对患者预后预测的意义。方法 回顾性分析邢台市中心医院 2020 年 12 月至 2024 年 10 月入住重症监护室（ICU）的200例脓毒症患者临床信息，将2020年12月至2022年11月接受常规经验性抗生素治疗的100例患者纳入对照组，将2022年12月至2024年10月以动态检测PCT结果作为抗生素用药指导的100例患者纳入指导组，比较两组PCT水平动态变化、抗生素疗程及耐药、预后情况；根据预后情况将对照组患者分为生存组（n=85）和死亡组（n=15），采用受试者工作特征（ROC）曲线分析动态PCT预测ICU脓毒症患者死亡的价值。结果 指导组治疗 3 d、5 d、7 d 时的 PCT 值［（1.20±0.24）ng/mL、（0.24±0.14）ng/mL、（0.15±0.07）ng/mL］均低于对照组［（1.44±0.25）ng/mL、（0.85±0.20）ng/mL、（0.25±0.18）ng/mL］，差异有统计学意义（P<0.05）。指导组治疗5 d时抗生素使用达标率（75.00%）高于对照组（55.00%，χ2=8.791，P=0.003）。指导组ICU治疗时间及治疗7 d、21 d、28 d累积死亡率［（12.22±2.35）d、2.00%、4.00%、6.00%］低于对照组［（14.55±2.56）d、9.00%、12.00%、15.00%］，差异有统计学意义（P<0.05）。生存组治疗1 d、3 d、5 d、7 d时的PCT值均低于死亡组，差异有统计学意义（P<0.05）。ROC 曲线分析显示，治疗 1 d、3 d、5 d、7 d 时的 PCT 值预测脓毒症患者死亡的曲线下面积分别为 0.714、0.768、0.770 和0.775。结论 动态监测ICU脓毒症患者PCT水平指导抗生素治疗，可以明显缩短抗生素疗程、降低多重耐药发生率，且能让患者获得更好的预后。
Abstract:Objective To explore the effects of dynamic monitoring of plasma procalcitonin（PCT）levels in patients with sepsis in guiding antibiotic treatment on course of treatment and drug resistance，and to evaluate its significance in predicting patient prognosis. Methods A retrospective analysis was performed on the clinical data of 200 patients with sepsis in ICU of Xingtai Central Hospital from December 2020 to October 2024. Among all patients，there were 100 cases in control group（routine empirical antibiotics treatment，December 2020 to November 2022）and 100 cases in guidance group（antibiotics treatment under the guidance of dynamic PCT monitoring，December 2022 to October 2024）. The dynamic changes of PCT levels，as well as antibiotics course，drug-resistance and prognosis were compared between the two groups. According to prognosis，patients in control group were divided into survival group（n=85）and death group（n=15）. The predictive value of dynamic PCT for death of sepsis patients in ICU was analyzed by receiver operating characteristic（ROC）curves. Results After 3 d，5 d and 7 d of treatment，PCT levels in guidance group were（1.20±0.24）ng/mL，（0.24±0.14）ng/mL and（0.15±0.07）ng/mL，lower than those in control group［（1.44±0.25）ng/mL，（0.85±0.20）ng/mL，（0.25±0.18）ng/mL］，the differences were statistically significant（P<0.05）. After 5 d of treatment，control rate of antibiotics use in guidance group was higher than that in control group（75.00% vs55.00%，χ2=8.791，P=0.003）. ICU treatment time and cumulative mortality rates after 7 d，21 d and 28 d of treatment in guidance group were（12.22 ± 2.35）d，2.00% ，4.00% and 6.00% ，significantly lower than those in control group［（14.55 ± 2.56）d，9.00%，12.00%，15.00%］（P<0.05）. After 1 d，3 d，5 d and 7 d of treatment，PCT levels in survival group were lower than those in death group，with statisticall significance（P<0.05）. ROC curves analysis showed that areas under the curve（AUC）values of PCT after 1 d，3 d，5 d and 7d of treatment for predicting death of sepsis patients were 0.714，0.768，0.770 and 0.775，respectively. Conclusion Dynamic monitoring of PCT levels in ICU patients with sepsis to guide antibiotic treatment can significantly shorten course of antibiotics and reduce incidence of multi-drug resistance，and enable patients to achieve better prognosis.
keywords: Dynamic monitoring Procalcitonin Sepsis Course of antibiotic Prognosis Multi⁃drug resistance
文章编号： 中图分类号：R631 R453.2 文献标志码：A
基金项目:邢台市重点研发计划项目（2020ZC294）
附件
| 作者 | 单位 |
| 苏丽 | 1. 邢台市中心医院门诊部, 河北 邢台 054000 |
| 张瑞英 | 2. 邢台市中心医院重症医学科, 河北 邢台 054000 |
| 李缺缺 | 2. 邢台市中心医院重症医学科, 河北 邢台 054000 |
| Author Name | Affiliation |
| SU Li *，ZHANG Ruiying，LI Queque | *Outpatient Department,Xingtai Central Hospital,Xingtai,Hebei 054000,China |
引用文本：
苏丽,张瑞英,李缺缺.动态监测脓毒症患者血浆降钙素原水平指导抗生素治疗对疗程及耐药性和预后的影响[J].中国临床研究,2025,38(11):1670-1674.
苏丽,张瑞英,李缺缺.动态监测脓毒症患者血浆降钙素原水平指导抗生素治疗对疗程及耐药性和预后的影响[J].中国临床研究,2025,38(11):1670-1674.