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目的:探讨血清降钙素原(PCT)监测对小儿细菌感染性肺炎合理使用抗生素的指导价值。方法:采用前瞻性、随机、对照研究方法,将2013年5月至2016年2月医院收治的284例细菌感染性肺炎患儿随机分为PCT指导组142例和标准治疗组142例,PCT指导组根据血清PCT含量指导抗生素使用,标准治疗组根据临床指导标准使用抗生素,比较两组抗生素使用率、抗生素使用时间、不良反应发生率、不良反应持续时间、住院率、住院时间及安全性。结果:PCT指导组抗生素使用率显著低于标准治疗组,抗生素使用时间、不良反应持续时间显著短于标准治疗组,两组比较差异具有统计学意义(P<0.05)。病情亚组分析显示,PCT指导的轻症亚组抗生素使用率、抗生素使用时间均显著低于标准治疗组(P<0.05),PCT指导的重症亚组抗生素使用时间显著低于标准治疗组(P<0.05);感染途径亚组分析显示,PCT指导的非社区获得性肺炎(CAP)患儿和CAP患儿抗生素使用率、抗生素使用时间均显著低于标准治疗组,组间比较差异具有统计学意义(P<0.05)。结论:血清PCT指导小儿细菌感染性肺炎抗生素使用,能够显著减少抗生素使用率,缩短抗生素使用时间,对规范抗生素使用、降低病原菌耐药性具有重要意义。
Objective: To investigate the value of serum procalcitonin (PCT) monitoring in the rational use of antibiotics in children with bacterial pneumonia. Methods: A total of 284 children with bacterial pneumonia admitted from May 2013 to February 2016 in our hospital were randomly divided into 142 cases of PCT-guided group and 142 of standard-therapy group. The PCT guidance The antibiotics were used according to the serum PCT content. The standard treatment group used antibiotics according to clinical guidelines. The antibiotic usage, antibiotic use time, incidence of adverse reactions, duration of adverse reactions, hospitalization rate, hospital stay and safety were compared between the two groups. Results: The antibiotic use rate in the PCT group was significantly lower than that in the standard treatment group. The duration of antibiotic use and duration of adverse reactions were significantly shorter than those in the standard treatment group. There was significant difference between the two groups (P <0.05). The subgroup analysis showed that the usage rate of antibiotics and the antibiotic use time in the subgroups treated with PCT were significantly lower than those in the standard treatment group (P <0.05), and those in the PCT subgroup were significantly lower than those in the standard treatment group (P <0.05). Subgroup analysis of infection route showed that the antibiotic use rate and antibiotic use time in PCT-guided children with non-community-acquired pneumonia (CAP) and CAP were significantly lower than the standard treatment group, the difference was statistically significant Significance (P <0.05). Conclusions: Serum PCT guided the use of antibiotics in children with bacterial pneumonia can significantly reduce the usage rate of antibiotics and shorten the use of antibiotics, which is of great significance to regulate the use of antibiotics and reduce the drug resistance of pathogens.