目的:探讨根据血清降钙素原测定值变化指导短程抗菌药物治疗复杂腹腔感染的安全性和有效性。方法:选择96例普通外科住院治疗的复杂腹腔感染患者,随机分为试验组(47例)和对照组(49例),留取各组基线血清降钙素原值。外科干预后每24 h测定血清降钙素原水平。试验组在血清降钙素原<0.5ng·ml^-1或下降至术后首次测定值的30%或以下,且临床症状缓解后停用抗菌药物;对照组病例在急性感染症状、体征消失,体温和血白细胞计数正常3 d后停用抗菌药物。比较两组出现手术部位感染、腹腔感染再发、30 d内死亡、首次抗菌药物疗程、30 d内无抗菌药物使用天数和住院时间的差异。结果:两组出现手术部位感染、腹腔感染再发、30 d内死亡的发生率及住院时间比较,差异均无统计学意义,而试验组的首次抗菌药物疗程明显短于对照组[(5.4±1.1) d vs.(8.6±1.4) d],30 d内无抗菌药物使用天数亦多于对照组[(23.7±2.4) d vs.(20.7±2.1) d]。结论:根据血清降钙素原水平指导复杂腹腔感染的抗菌药物治疗可明显缩短疗程,减少抗菌药物暴露,不增加死亡率及不良事件发生率,安全有效。

[1] SOLOMKIN J S,MAZUSKI J E,BRADLEY J S,et al.Diagnosis and management of complicated intra-abdominal infection in adults and children:guidelines by the surgical infection society and the infectious diseases society of America[J].Surg Infect(Larchmt),2010,11(1):79-109.
[2] 吴孟超,吴在德.黄家驷外科学[M].7版.北京:人民卫生出版社,2008:117.
[3] SCHUETZ P,CHIAPPA V,BRIEL M,et al.Procalcitoninalgorithms for antibiotic therapy decisions:a systematic review of randomized controlled trials and recommendations for clinical algorithms[J].Arch Intern Med,2011,171(15):1322-1331.
[4] NOBRE V,HARBARTH S,GRAF J D,et al.Use of procalcitonin to shorten antibiotic treatment duration in septic patients:a randomized trial[J].Am J RespirCrit Care Med,2008,177(5):498-505.
[5] HOCHREITER M,KÖHLER T,SCHWEIGER A M,et al.Procalcitonin to guide duration of antibiotic therapy in intensive care patients:a randomized prospective controlled trial[J].Crit Care,2009,13(3):R83.
[6] WACKER C,PRKNO A,BRUNKHORST F M,et al.Procalcitonin as a diagnostic marker for sepsis:a systematic review and meta-analysis[J].Lancet Infect Dis,2013,13(5):426-435.
[7] SARTELLI M,CATENA F,ANSALONI L,et al.Complicated intra-abdominal infections worldwide:the definitive data of the CIAOW Study[J].World J Emerg Surg,2014,9:37.
[8] DUPONT H,FRIGGERI A,TOUZEAU J,et al.Enterococci increase the morbidity and mortality associated with severe intra-abdominal infections in elderly patients hospitalized in the intensive care unit[J].J Antimicrob Chemother,2011,66(10):2379-2385.
[9] SAWYER R G,CLARIDGE J A,NATHENS A B.et al.Trial of short-course antimicrobial therapy for intraabdominalinfection[J].N Engl J Med,2015,372(21):1996-2005.
[10] BECKER K L,NYLÉN E S,WHITE J C,et al.Procalcitonin and the calcitonin gene family of peptides in inflammation,infection,and sepsis:a journey from calcitonin back to its precursors[J].J Clin Endocrinol Metab,2004,89(4):1512-1525.
[11] LEE H.Procalcitonin as a biomarker of infectious diseases[J].Korean J Intern Med,2013,28(3):285-291.