支气管哮喘急性发作时抗生素应用的危险因素分析

Acute exacerbation of bronchial asthmarisk factors of antibiotic

目的 分析支气管哮喘（简称哮喘）急性发作患者应用抗生素治疗的危险因素.方法 选取我科2010年6月至201 3年6月间收治的符合分析要求的哮喘急性发作患者97例,全部测定血清降钙素原（PCT）,并随机分为对照组（46例）和治疗组（51例）.在相同的基础治疗上,对照组由经治医师根据经验应用抗生素;治疗组在PCT≥0.25 μg/L时应用抗生素,否则不用.在病例治愈的前提下证明当PCT≥0.25 μg/L时可作为哮喘急性发作时抗生素应用的安全指标.同时记录所有病例入科时的咳痰性状、病情严重程度、体温、C反应蛋白及末梢血白细胞记数作为抗生素应用的可能危险因素.再用该危险因素和以PCT≥0.25 μg/L作为应用抗生素的指标之间做相关性分析.结果 治疗组抗生素应用率（47.1％）比对照组（80.4％）低,差异有统计学意义（P＜0.05）;同时,当PCT≥0.25 μg/L时与咳痰较发作前增加或咳黄脓痰、病情严重程度分级为重-危重度有相关性（P＜0.05）.结论 哮喘急性发作患者,咳痰较发作前增加或咳黄脓痰、病情严重程度分级为重-危重度时需要用抗生素;有发热（P=0.050）则为抗生素应用的临界点,可综合考虑是否应用.而C反应蛋白升高或白细胞升高时则不是应用抗生素的依据.

Objective Analysis of patients with acute exacerbation of bronchial asthma （asthma）,antibiotic treatment of reference.Methods Select our department from July 2010 to July 2013 were treated in line with the requirements analysis in patients with acute exacerbation of bronchial asthma in 97 cases,all serum procalcitonin （PCT）,and randomly divided into control group （46 cases） and treatment group （51 cases）.Treatment on the same basis,the control group by the treating physician based on experience with antibiotics.Treatment group in PCT≥0.25 μg/L when the use of antibiotics,otherwise do not.In cases cured under the premise of the rate of antibiotics were compared.Record all cases of sputum into the subjects of traits,disease severity,body temperature,C-reactive protein （CRP） and peripheral blood leukocyte count （WBC） as possible risk factors for antibiotics,and in PCT≥0.25 μg/L as the standard antibiotics do correlation analysis between.Results Rate of antibiotic treatment group （47.1%） than the control group （80.4%）,and the difference was statistically significant （P 〈0.05）.Meanwhile,when the PCT ≥ 0.25 μg/L when compared with before the on set of increased sputumorcough yellow purulent sputum,clinical severityas the most important-acriticaldegree ofcorrelation （P 〈 0.05）.Conclusions Patients with acute exacerbation of bronchialasthma,increased sputumor cough than before the onset of yellowpurulent sputum,clinical severityas the most importantwhen youneed to use antibiotics criticaldegree.Only fever,orelevated CRP or elevated WBC which a factor must be applied when it is not in accordance with antibiotics.