血清降钙素原在卒中相关性肺炎的临床应用价值

Clinical application value of serum procalcitonin in the treatment of stroke associated pneumonia

目的探讨血清降钙素原(PCT)在卒中相关性肺炎(SAP)中的临床应用价值,为SAP的诊断治疗提供依据。方法收集2013年7月-2015年3月在医院住院100例SAP患者,随机分为常规治疗组(对照组)与PCT指导治疗组(试验组)各50例,检测患者临床肺部感染评分(CPIS)、气管分泌物性状、胸片资料、体温、血常规、气管吸出物细菌培养,对比分析两组患者抗菌药物限定日剂量(DDD值)、抗菌药物使用时间、CPIS评分、炎性指标(WBC、CRP、PCT)、因肺炎病死率、肺炎相关住院天数、肺炎相关医疗费用等各项指标的差异。结果治疗前两组患者各项临床指标(CPIS评分、WBC、CRP、PCT)差异无统计学意义;治疗1d后两组患者CPIS评分、炎性指标差异无统计学意义,治疗5d后试验组明显低于对照组;比较DDD值、抗菌药物使用时间、肺炎相关住院天数、肺炎相关医疗费用等各项指标,试验组低于对照组,差异有统计学意义,肺炎病死率对照组高于试验组,但差异无统计学意义。结论监测PCT水平可作为SAP患者诊断、治疗及指导临床用药的良好临床指标,在SAP诊治中发挥一定的作用。

OBJECTIVE To explore the clinical application value of serum procalcitonin（PCT）in the treatment of stroke associated pneumonia（SAP）,so as to provide evidence for the diagnosis and treatment of SAP.METHODS A total of 100 SAP patients hospitalized in our hospital from Jul.2013 to Mar.2015 were collected,and randomly divided into conventional treatment group（control group）and the guidance of PCT in treatment group（test group）,with 50 cases in each group.The clinical pulmonary infection score（CPIS）,tracheal secretions,chest Xray data,body temperature,blood routine,and trachea suck out bacterial culture of the patients were detected.The antibiotics limit daily dose（DDD）,antibiotic use time,CPIS,inflammatory indicators（WBC,CRP,PCT）,pneumonia related mortality,pneumonia related pneumonia hospitalization days,and medical cost of the two groups were compared.RESULTS The general indicators（CPIS,WBC,CRP,and PCT）of the two groups of patients had no significance.The CPIS score and inflammatory indexes had no significance of the two groups 1day after treatment.Five days after treatment,the CPIS score and inflammatory indexes of test group were significantly lower than those of control group.Full use of antimicrobial treatment limit daily dose（DDD）,antibiotic use time,pneumonia related hospitalization days,and pneumonia related medical cost of test group were significantly lower than those of control group.The pneumonia related mortality of control group was higher than that of test goup,the pneumonia related mortality of control group was higher than that of test group,but the difference was not significant.CONCLUSION PCT level can be monitored as a good clinical indicator for the diagnosis,treatment and clinical medication of SAP patients,and can play a role in the diagnosis and treatment of SAP.