降钙素原对短程抗菌药物治疗老年缺血性卒中相关性肺炎的指导价值

Value of serum procalcitonin guidance on short-duration antibiotic therapy in elderly patients with ischemic stroke complicated with stroke-associated pneumonia

目的探讨监测血清降钙素原（PCT）水平对短程抗菌药物治疗老年缺血性卒中相关性肺炎（SAP）的指导价值。方法 125例符合标准的老年缺血性卒中后SAP患者随机分为常规抗菌药物治疗组（常规组）和短程抗菌药物治疗组（短程组）。常规组62例患者由经治医生按照我国抗菌药物使用指南进行抗菌药物治疗并决定抗菌药物疗程;短程组63例患者在使用抗菌药物5 d后,进行连续PCT监测,在血清PCT〈0.25μg/L并且体温正常时,停用抗菌药物,否则继续使用抗菌药物至体温正常后停用抗菌药物。观察2组患者的住院时间、抗菌药物疗程、临床有效率以及治疗后28 d病死率、美国国立卫生研究院卒中量表（NIHSS）评分和Barthel指数。出院后继续随访6月,采用Kaplan-Meier生存曲线比较2组患者生存率。结果短程组与常规组患者在临床有效率、治疗后28 d病死率、NIHSS评分和Barthel指数方面比较,差异无统计学意义（P均〉0.05）。短程组的住院时间[（11.9±3.1）d]和抗菌药物疗程[（7.3±1.5）d]均短于常规组[分别为（14.2±5.2）d和（10.2±2.5）d,P均〈0.05]。6月随访期结束时共有7例死亡,死亡率为6.0%,其中常规组死亡3例,短程组死亡4例。Kaplan-Meier分析表明,2组患者6月生存率差异无统计学意义（χ^2=0.150,P=0.699）。结论监测PCT水平用于指导老年SAP的短程抗菌药物疗法是安全的,能够缩短患者抗菌药物疗程和住院时间。

Objective To evaluate the value of serum procalcitonin（ PCT） guidance on short-duration antibiotic therapy in elderly patients with ischemic stroke complicated with stroke-associated pneumonia（ SAP）. Methods 125 eligible elderly patients with ischemic stroke with SAP were randomly assigned into two groups： standard antibiotic therapy group（ standard group,n = 62） and short-duration antibiotic group（ short-duration group,n = 63）.Standard group received antibiotics according to the physician＇s advice and short-duration group was treated with antibiotics according to serum PCT level. If PCT 0. 25 μg / L and patients had no fever,antibiotic would be stopped. Length of hospitalization,duration of antibiotics,clinical efficacy,mortality,NIHSS and Barthel index on the 28 th day were observed and compared between two groups. A Kaplan-Meier survive curve was constructed to assess the 6-month survival. Results Clinical efficacy,mortality,NIHSS and Barthel index on the 28 th day were similar in two groups（ P〈0. 05）. The length of hospitalization[（ 11. 9±3. 1） d]and antibiotic duration [（ 7. 3±1. 5） d]in short-duration group were shorter than those of standard group[（ 14. 2±5. 2） d and（ 10. 2±2. 5） d,P〈0. 05]. The Kaplan-Meier survival curve showed that 6-month mortality rate was similar in two groups（ χ^2= 0. 150,P = 0. 699）. Conclusions Monitoring PCT is safe to guide short-duration antibiotic therapy in elderly patients with ischemic stroke complicated with SAP,and antibiotic duration and length of hospitalization can be reduced.