降钙素原监测老年吸入性肺炎抗菌治疗的价值

Significance of dynamic monitoring of serum procalcitonin level in treatment of elderly patients with aspiration pneumonia

目的动态监测患者血清降钙素原(PCT)水平,为治疗老年吸入性肺炎抗菌药物的合理使用提供参考。方法选取医院2011年1月-2013年1月老年吸入性肺炎住院患者52例,随机分为常规组25例、PCT监测组27例,常规组按经验性治疗方案使用抗菌药物,监测组根据血清PCT浓度变化指导抗菌药物使用,分别比较两组患者抗菌药物使用率、疗程、血白细胞(WBC)计数及中性粒细胞比例(N)、C-反应蛋白(CRP)、APACHEⅡ评分、临床有效率、平均住院时间的差异。结果抗菌药物平均使用疗程PCT监测组为(9.7±2.3)d、常规组为(12.9±1.8)d(P<0.05),抗菌药物使用率PCT监测组为85.2%、常规组为92.0%(P<0.05);治疗后PCT监测组WBC、N、CRP、APACHEⅡ评分及临床治疗有效率与常规组差异无统计学意义;监测组平均住院时间(13.9±4.5)d,常规组(19.2±5.8)d,差异有统计学意义(P<0.05)。结论在老年吸入性肺炎患者治疗过程中,参考血清PCT水平的动态变化,可减少抗菌药物的使用,缩短住院时间。

OBJECTIVE To dynamically monitor the serum procalcitonin （PCT ） levels so as to provide guidance for reasonable use of antibiotics for treatment of the elderly patients with aspiration pneumonia .METHODS A total of 52 elderly patients with aspiration pneumonia who were hospitalized from Jan 2011 to Jan 2013 were enrolled in the study and randomly divided into the conventional group with 25 cases and the PCT monitoring group with 27 ca‐ses ,then the conventional group was treated with antibiotics based on the empirical therapy program ,the monito‐ring group was administrated based on the change of the serum PCT concentration ;the utilization rate of antibiot‐ics ,treatment course ,white blood cells （WBC） counts ,proportion of neutrophils （N） ,C‐reactive protein （CRP） , APACHEII score ,clinical effective rate ,and mean length of hospital stay were observed and compared between the two groups .RESULTS The mean course of drug therapy was （9 .7 ± 2 .3） days in the PCT monitoring group , （12 .9 ± 1 .8） days in the conventional group （P〈0 .05）;the utilization rate of antibiotics was 85 .2% in the PCT monitoring group ,92 .0% in the conventional group （P〈0 .05） .After the treatment ,there was no statistically significant difference in the WBC counts ,proportion of N ,CRP ,APACHEⅡ score ,or effective rate of clinical treatment between the PCT monitoring group and the conventional group .The mean length of hospital stay was （13 .9 ± 4 .5） days in the monitoring group ,（19 .2 ± 5 .8） days in the conventional group ,there was statistically significant difference （P〈0 .05） .CONCLUSION For the treatment of the elderly patients with aspiration pneumo‐nia ,the dynamic monitoring of the serum PCT level can contribute to the reduction of use of antibiotics as well as the length of hospital stay .