血清降钙素原危急值与血清炎性指标检测在心血管内科感染重症患者的临床意义

Clinical significance of critical value of serum procalcitonin and serum inflammatory factors in severe cardiovascular disease patients with infection

目的探讨血清炎性指标与降钙素原危急值在抗菌药物对心血管内科感染重症患者的检测及其临床意义。方法选择2013年6月-2015年12月心血管内科感染重症患者180例,分为观察组与对照组,各90例;对照组接受常规治疗,观察组在此基础上,根据血清降钙素原危急值监测结果给予抗菌药物治疗;比较两组疗效,抗菌药物使用时间、使用率;分析治疗前后血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平变化。结果治疗结束后,观察组总有效率94.44%,显著高于对照组85.56%,差异有统计学意义(P<0.05);观察组患者抗菌药物使用时间总计(3.1±1.2)d,显著低于对照组(5.8±2.3)d,差异有统计学意义(P<0.05);观察组患者治疗后未见复发病例,对照组复发6例,两组复发率比较,差异有统计学意义(P<0.05);两组患者治疗后血清hS-CRP水平均有显著改善,且观察组显著优于对照组,差异有统计学意义(P<0.05);两组患者治疗后血清IL-6、IL-8与TNF-α水平均有显著改善,且观察组显著优于对照组,差异有统计学意义(P<0.05)。结论针对心血管内科感染重症患者,可根据血清降钙素原危急值的变化情况合理应用抗菌药物治疗,且疗效较好;通过合理控制抗菌药物用法用量,可减少对患者的伤害,安全性较高。

OBJECTIVE To explore the clinical significance of detection of serum inflammatory factors and critical value of procalcitonin （PCT） in severe cardiovascular disease patients with infection. METHODS A total of 180 patients with severe infection who were treated in cardiovascular medicine department from Jun 2013 to Dec 2015 were enrolled in the study and divided into the observation group and the control group, with 90 cases in each group. The control group was given the conventional therapy, while the observation group was treated with anti- biotics based on the critical value of serum PCT. The clinical efficacy, time of use of antibiotics, and utilization rate were compared between the two groups the changes of serum C-reactive protein （CRP）, interleukin-6 （IL- 6）, interleukin-8 （IL-8）, and tumor necrosis factor-α（TNF-α） levels were observed before and after the treat- ment. RESULTS The total effective rate of treatment of the observation group was 94.44%, significantly higher than 85.56% of the control group （P〈0.05）, The total time of use of antibiotics of the observation group was （3. 1±1.2） days, significantly shorter than （5.8±2.3） days of the control group （P〈0.05）. There was no case of recurrence in the observation group and 6 cases of recurrence in the control group after the treatment, and the difference in the recurrence rate was significant between the two groups （P〈0.05）. The serum hS-CRP level of the two groups of patients was remarkably improved after the treatment, which was significantly better in the ob- servation group than in the control group （P〈0.05）. The serum IL-6, IL-8, and TNF-a levels of the two groups of patients were remarkably improved after the treatment, which were significantly better in the observation group than in the control group （P〈0.05）. CONCLUSION It is necessary to reasonably use antibiotics for treatment of the cardiovascular disease patients with severe infection based on the critical value of serum PCT, and the clinical efficacy is good. The reasonable control of dosage of antibiotics may reduce the harm to the patients, and the safe ty is high.