文档介绍：PCT临床应用—指导抗生素治疗
ICU
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内容
PCT特点、应用
指导抗生素治疗
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PCT
PCT是降钙素无激素活性的前肽物质，116个氨基酸组成的糖蛋白，分子质量约13 ku，由甲状腺C细胞合成
lactates
Muller et al.,Circulation 2004
在感染性心内膜炎的早期诊断上，PCT体现出比CRP更好的诊断灵敏度和特异性
1-
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细菌感染严重程度判断
在感染疾病的发展过程中，PCT随着严重程度的不同（局部感染、脓毒血症、严重脓毒血症、脓毒性休克），呈现由低到高的浓度变化
PCT血中浓度与病程发展呈正相关
对于感染程度及器官机能障碍的严重性进行准确的判断
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. Giamarellos-Bourboulis et al.,Jan 07 ... Sept. 2008 ....
Mortality Rate in Patients with Sepsis....
(The Hellenic Sepsis Study Group)
Outside ICU:
- PCT < ng/ml:
Mortality rate: %
- PCT > ng/ml:
Mortality rate %
Inside ICU:
- PCT < ng/ml:
Mortality rate %
- PCT > ng/ml:
Mortality rate %
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报警值: 所有数值 > , 从第一天高于
非报警值:从第一天高于 ,并以后数值均 <
共472病人 (343 PCT > )
中位数
生存者
死亡者
PCT
CRP
mg/L
mg/L
WBC
109/L
109/L
Jensen et al., Crit Care Med, 2006
PCT浓度变化与ICU脓毒症患者生存率的关系
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指导抗生素治疗
是否需要抗生素处方？
评估抗生素治疗成功与否？
什么时候停抗生素 ?
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抗生素治疗每延迟1小时，死亡率上升7%
Kumar et al., CCM 2006
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D. Antimicrobial Therapy
We recommend that intravenous antimicrobial therapy be started as early as possible and within the first hour of recognition of septic shock (grade 1B) and severe sepsis without septic shock (grade 1C). Appropriate cultures should be obtained before initiating antibiotic therapy but should not prevent prompt administration of antimicrobial therapy
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D. Antimicrobial Therapy
We suggest the use of low procalcitonin levels or similar biomarkers might be useful to assist the clinician in the discontinuation of empiric antibiotics in patients who appeared septic, but have no subsequent evidence of infection (grade 2C).
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Thirty-three studies fulfilled inclusion criteria (3,943 patients, 1,828 males, 922 females; mean age: yrs;1,825 patients with sepsis, severe sepsis, or septic shock; 1,545 with only systemic inflammatory response syndrome); eight stud