老年心衰合并肺部感染患者监测降钙素原水平对抗感染治疗的指导意义

Significance of Monitoring PCT Level of Senile Patients with Heart Failure and Lung Infection in Guiding the Anti-infection

目的探讨降钙素原(procalcitonin,PCT)在老年心衰合并肺部感染中抗感染治疗的临床意义。方法选取潍坊市人民医院2016年2月—2017年1月期间收治的符合纳入标准的120例老年心衰患者,随机的分成对照组及试验组,每组60例,对照组根据患者临床症状、体征和病情变化决定抗菌治疗,试验组则依据测得的血清PCT水平变化决定抗感染的治疗。比较两组抗菌药品使用情况。结果对照组抗感染药物花费为(3 746.01±382.30)元;试验组抗感染药物花费为(1 452.00±281.52)元,两者差异有统计学意义(t=37.472,P<0.05);对照组与试验组抗感染疗程分别为:(14.10±4.82)、(12.30±3.54)d,两者之间差异有统计学意义(t=2.331,P<0.05);两组在二重感染率方面,对照组二重感染10例,试验组二重感染2例,差异有统计学意义(χ~2=5.926,P<0.05);对照组与试验组平均住院日分别为:(15.56±5.16)、(14.72±4.98)d,两者之间差异无统计学意义(t=0.907,P>0.05);对照组在治疗过程中死亡9例,病死率为15.00%;试验组死亡5例,病死率为8.33%,两组病死率差异无统计学意义(χ~2=1.24,P>0.05)。对照组临床有效率78.33%,试验组临床有效率81.67%,两者差异无统计学意义(Z=-0.931,P>0.05)。结论针对老年心衰合并肺部感染患者,根据PCT水平指导抗生素使用,可以减少住院总费用,减少抗生素使用量,降低二重感染率。

Objective To study the clinical significance of monitoring PCT level of senile patients with heart failure and lung infection in guiding the anti-infection. Methods 120 cases of senile heart failure patients meeting the inclusion standardized in our hospital from February 2016 to January 2017 were selected and randomly divided into two groups with 60 cases in each, the clinical symptoms, vital signs and changes of diseases in the control group determined the antibacterial treatment, and in the test group, the antiinfection treatment was determined by the changes of serum PCT level, and the use of antibacterial drugs was compared between the two groups. Results The cost of anti-infection drugs accounted for（3 746.01±382.30）yuan, and the expense of anti-infection drugs in the test group accounted for（1 452.00±281.52）yuan, and the differences between the two groups were statistically significant（t=37.472,P〈0.05）,and the anti-infection treatment course in the control group and in the test group was respectively（14.10±4.82）d and（12.30±3.54）d, and the difference was statistically significant（t=2.331,P〈0.05）, and the difference in the double infection between the control group and the test group was obvious, with statistical significance（10 cases vs 2 cases）（χ2=5.926,P〈0.05）, and the average length of stay in the control group and in the test group was respectively（15.56±5.16）d and（14.72±4.98）d, and the difference between the two groups was not statistically significant（t=0.907,P〉0.05）, and the death rate and mortality rate in the treatment group between the control group and the test group were not obvious（9 cases, 15.00% vs 5 cases, 8.33%）（χ2=1.24,P〉0.05）, and the clinical effective rate in the control group and in the test group was respectively 78.33% and 81.67%, and the difference was not statistically significant（Z =-0.931,P 〉0.05）.Conclusion We should guide the use the antibodies according to the PCT level of senile patients with heart failure and lung infection, which can reduce the total length of stay, and reduce the usage of antibodies and reduce the double infection rate.