抗生素治疗重症肺炎患者血清降钙素原的动态监测

Dynamic monitoring of serum procalcitonin in patients with severe pneumonia by antibiotic therapy

目的分析动态监测血清降钙素原(PCT)在指导重症肺炎患者抗生素使用中的价值。方法选取192例重症肺炎患者,随机分为观察组和对照组各96例。观察组采用PCT指导抗生素治疗,对照组采用常规经验指导抗生素治疗。在治疗1、4、7 d及ICU转出前检测并比较2组血清PCT、白细胞计数(WBC)、C反应蛋白(CRP)水平。比较2组患者抗生素使用情况。结果 2组治疗不同时间点PCT水平均显著降低,且观察组PCT水平均显著低于对照组(P <0. 05)。2组WBC在ICU转出前显著下降(P <0. 05)。2组治疗后不同时间点CRP水平均显著降低(P <0. 05),且观察组治疗4、7 d后CRP水平显著低于对照组(P <0. 05)。观察组抗生素使用例数、抗生素使用时间、抗生素品种、抗生素使用强度、ICU停留时间均显著优于对照组(P <0. 05)。结论动态监测PCT水平可指导重症肺炎患者抗生素使用,提高抗感染治疗效果,降低抗生素用药时间和用药量。

Objective To analyze the value of dynamic monitoring of serum procalcitonin （PCT） in guiding the use of antibiotics for patients with severe pneumonia. Methods A total of 192 patients with severe pneumonia were randomly divided into observation group and control group, with 96 cases in each group. The observation group used PCT to guide antibiotic treatment, while the control group used conventional experience to guide antibiotic therapy. The levels of PCT, white blood cell count （WBC） and C reactive protein （CRP） were detected and compared at 1 st , 4 th , 7 th days of treatment and before the out of ICU. Antibiotic use was compared between the two groups. Results The levels of PCT at different time points reduced significantly in both groups （ P 〈0.05）, and PCT levels at different time points in observation group were significantly lower than control group （ P 〈 0.05）. The WBC in both groups decreased significantly before the out of ICU （ P 〈0.05）. The levels of CRP significantly reduced at different time points in both groups （ P 〈0.05）, and the levels of CRP at 4 th , 7 th days of treatment in the observation group were significantly lower than those in the control group （ P 〈0.05）. The cases with antibiotic use, antibiotic use time, antibiotic varieties, antibiotic use intensity and time in ICU in the observation group were significantly better than those in the control group （ P 〈0.05）. Conclusion Dynamic monitoring of PCT level can guide the use of antibiotics in patients with severe pneumonia, improve the effect of anti-infection treatment, reduce the medication time and dosage of antibiotics.