C反应蛋白和降钙素原指导高危新生儿预防性应用抗生素的效果、安全性和经济性分析

目的:评价应用C反应蛋白（C reaction protein，CRP）和降钙素原（procalcitonin，PCT）指导高危新生儿预防性应用抗生素的效果、安全性和经济性。方法:选取2015年7月至2017年1月慈溪市妇幼保健院收治的高危新生儿124例作为研究对象，随机数表法分为对照组（62例）和实验组（62例），对照组患儿均给予预防性应用抗生素治疗，实验组根据CRP和PCT选择性应用抗生素。比较两组患儿的细菌培养阳性率、脓毒症发生率以及不良反应发生率。结果:两组患儿的CRP和PCT水平和阳性率间均不存在统计学差异（t/χ2=0.299，-0.461，0.292，0.544，0.186，P=0.766，0.646，0.589，0.461，0.666）。两组患儿治疗前后的菌培养阳性率间均不存在统计学差异（χ2=0.040，0.287，P=0.842，0.592）；两组治疗后的菌培养阳性率均明显低于治疗前（χ2=47.825，40.367，P=0.000，0.000）；两组患儿脓毒症的发生率分别为12.90%和14.52%，差异无统计学意义（χ2=0.068，P=0.794）。实验组的NICU治疗和住院时间、机械通气时间以及治疗费用均显著低于对照组（t=2.904，2.729，2.152，5.337，P=0.004，0.007，0.033，0.000），两组的机械通气率间无统计学差异（χ2=0.372，P=0.542）。对照组患儿不良反应发生率为19.35%，明显高于实验组的6.46%（χ2=4.593，P=0.032）。结论:应用CRP和PCT指导高危新生儿预防性应用抗生素的效果与普遍性应用相似，可以明显减少治疗时间和治疗费用，明显降低治疗相关不良反应。

Analysis of the efficacy,safety and economics of prophylactic antibiotics in high-risk neonates guided by C reaction protein and procalcitonin

AIM: To evaluate the efficacy, safety and economics of C reaction protein (CRP) and procalcitonin (PCT) in the prevention of the use of antibiotics in high-risk newborns. METHODS:One hundred and twenty-four cases of high risk neonates treated in our hospital from July 2015 to January 2018 were selected as the research subjects and were divided into the control group (62 cases) and the experimental group (62 cases) by random digital tables. The children in the control group were treated with prophylactic antibiotic treatment. The experimental group was treated with selective antibiotics according to the level of CRP and PCT. The positive rate of bacterial culture, the incidence of sepsis and the incidence of adverse reactions were compared between the two groups. RESULTS:There was no statistical difference between the levels of CRP and PCT and the positive rate in the two groups (t/χ2=0.299, -0.461, 0.292, 0.544, 0.186, P=0.766, 0.646, 0.589, 0.461, 0.666). There was no statistical difference in the positive rates of bacteria culture before and after treatment in the two groups (χ2=0.040, 0.287, P=0.842, 0.592), and the positive rate of bacteria culture in the two groups was significantly lower than that before treatment (χ2=47.825, 40.367, P=0.000, 0.000), and the incidence of sepsis in two groups was 12.90% and 14.52%, respectively, which have no statistical significance (χ2=0.068, P=0.794). The NICU treatment in the experimental group was significantly lower than that in the control group (t=2.904, 2.729, 2.152, 5.337, P=0.004, 0.007, 0.033, 0.000), and there was no statistical difference between the two groups (χ2=0.372, P=0.542). The incidence of adverse reactions in the control group was 19.35%, which was significantly higher than that in the experimental group (6.46%, χ2=4.593, P=0.032). CONCLUSION:The effect of preventive use of antibiotics under the guidance of CRP and PCT in high-risk newborns show similar efficay of universal application, which can significantly reduce treatment time and treatment costs, obviously reduce treatment-related adverse reactions and improve the short-term prognosis.