2020 年第 9 期 第 15 卷

血清降钙素原在重症患者个体化抗感染治疗中的价值探讨

The value of serum procalcitonin in the individualized anti-infective treatment of severe patients

作者：张蕾1徐强1郭利涛1李萌1赵璇1王芳1樊静群1雷金娥2

英文作者：Zhang Lei1 Xu Qiang1 Guo Litao1 Li Meng1 Zhao Xuan1 Wang Fang1 Fan Jingqun1 Lei Jin′e2

单位：1西安交通大学第一附属医院重症医学科710061；2西安交通大学第一附属医院检验科710061

英文单位：1Intensive Care Unit the First Affiliated Hospital of Xi′an Jiaotong University Xi′an 710061 China; 2Clinical Laboratory the First Affiliated Hospital of Xi′an Jiaotong University Xi′an 710061 China

关键词：重症患者；降钙素原；抗菌药物；两步法；个体化

英文关键词：Criticallyillpatients；Procalcitonin；Antibiotic；Two-stepsmethod；Individualized

• 摘要：

• 目的 探讨血清降钙素原在重症患者个体化抗感染治疗中的价值。方法 回顾性分析2017年11月24日西安交通大学第一附属医院重症医学科收治的1例重症感染患者的临床、影像学及病原学资料，对抗菌药物的药代动力学/药效动力学（PK/PD）特点以及药物剂量调整进行分析总结。结果 该例71岁男性患者入院时病情危重，感染指标升高，降钙素原＞100 μg/L，并伴有肾功能不全，经验性给予美罗培南抗感染治疗，并根据肌酐清除率调整抗菌药物剂量为美罗培南1.0 g静脉点滴，1次/12 h，2017年11月27日降钙素原81.390 μg/L。血及尿培养均为产超广谱β内酰胺酶大肠埃希菌，根据药敏结果结合患者脏器功能选择抗菌药物，根据抗菌药物的PK/PD特点优化抗菌药物使用，使用美罗培南时，采用两步法给药，前0.5 g静脉点滴0.5 h，后0.5 g静脉点滴2.5 h，并对抗菌药物进行个体化调整，以发挥最大疗效，2017年12月15日降钙素原0.200 μg/L。最终患者好转出院，随访3个月未复发。结论 对于重症感染患者，在降钙素原指导下制定并调整抗感染策略，利用抗菌药物的PK/PD特点优化抗菌药物治疗，实现精准化、个体化治疗，能提高重症患者的救治成功率。

• Objective To explore the value of procalcitonin in the anti-infective treatment of severe individual patients. Methods The clinical, imaging and etiological data of a severe patient admitted to the intensive care unit, First Affiliated Hospital of Xi′an Jiaotong University on November 24, 2017, were analyzed. The pharmacokinetics/pharmacodynamics (PK/PD) characteristics of antibacterial drugs and the adjustment of drug dose were analyzed. Results The patient was a 71 years old male. He was in critical condition upon admission with increased infection indicators, procalcitonin＞100 μg/L, and renal insufficiency. This patient was given anti-infective therapy with meropenem; the antimicrobial dose was adjusted to 1.0 g intravenous drip of meropenem based on creatinine clearance, once per 12 hours. The original calcitonin was 81.390 μg/L on November 27, 2017. Both blood and urine cultures were Extended-spectrum β-lactamase-producing Escherichia coli. Meropenem was selected for treatment based on the drug sensitivity results and the PK/PD characteristics of antibacterial drugs. Meropenem was given in two steps, with a 0.5 h intravenous drip for the first 0.5 g and a 2.5 h intravenous drip for the last 0.5 g; the antimicrobial drug was adjusted. The procalcitonin was 0.200 μg/L on December 15, 2017.  He was followed up for 3 months without recurrence.Conclusion For patients with severe infection, the anti-infective strategy was formulated and adjusted under the guidance of procalcitonin; the PK/PD characteristics of antibacterial drugs can be used to optimize antibiotic treatment.