应用血清降钙素原浓度指导抗生素治疗急性脑梗死发热的效果分析

The value of serum procalcitonin in treatment of pyrexia after acute cerebral infarction

目的研究血清降钙素原(PCT)测定在急性脑梗死后发热治疗中的作用。方法选取2005年9月至2007年11月年复旦大学附属上海市第五人民医院住院的急性脑梗死伴发热患者133例,分为常规治疗组66例(常规组)和PCT指导治疗组67例(PCT组)。常规组由经治医生按照抗生素使用指南决定抗生素治疗方案,PCT组按照血清PCT质量浓度决定是否使用抗生素。观察两组患者的住院时间、临床有效率、住院费用、抗生素费用、抗生素使用率以及治疗后28d病死率、美国国立卫生院卒中量表(NIHSS)评分和Barthel指数评分(BI)。结果两组患者在住院时间、临床有效率、治疗后28d病死率、NIHSS评分和BI指数方面比较,差异无统计学意义,PCT组的平均住院费用、抗生素费用及抗生素使用率[分别为6558(3774,9647)元、2673(1352,5287)元、70.1%]均低于常规组[分别为8373(4852,12533)元、4194(2869,7055)元、85.7%](均P<0.05)。结论急性脑梗死伴发热患者在PCT指导下使用抗生素,能够减少抗生素使用量,降低平均住院费用。

Objective To evaluate the value of serum procalcitonin（PCT） in treatment of pyrexia after acute cerebral infarction. Methods A total of 133 patients requiring hospitalization for acute cerebral infarction were randomly assigned into two groups ： standard therapy group （ standard group, n = 66 ） and PCT-gnided group （ PCT group, n = 67 ）. Standard group received antibiotics according to the attending physicians and PCT group were treated with antibiotics according to serum PCT levels. Length of hospitalization, clinical efficacy, costs of hospitalization and antibiotics, rate of antibiotics use, mortality, NIHSS and BI on the 28th day were observed. Results Length of hospitalization, clinical efficacy, mortality, NIHSS and BI on the 28th day were similar in two groups. Costs of hospitalization and antibiotics and rate of antibiotics use in PCT group[ 6558 （ 3774,9647 ） yuan, 2673 （ 1352,5287 ） yuan, 70. 1% ] were lower than those in standard group [8373（4852,12533）ynan,4194（2869,7055）yuan,85. 7% ] （P 〈0. 05）. Conclusion PCT guidance reduced antibiotics use and lowered costs of hospitalization in treatment of pyrexia after acute cerebral infarction.