血清降钙素原在AECOPD抗感染治疗中的应用价值研究

Study on the Application Value of Serum Calcitonin in the Anti Infection Treatment of AECOPD

目的探讨血清降钙素原在慢性阻塞性肺疾病急性加重期抗感染治疗中的变化水平,评价其指导使用抗生素的临床价值。方法选取2013年9月~2016年9月我科收治的264例AECOPD患者,随机分为PCT组和对照组,每组132例。对照组患者根据医生临床经验决定是否接受抗生素治疗。PCT组根据血清PCT水平决定抗生素治疗,PCT水平≥0.25μg/L时应用抗生素,当PCT水平<0.25μg/L时停用抗生素。比较两组患者抗生素的使用率及使用时间、住院时间、二重感染、呼吸机辅助通气、死亡率和临床有效率等指标。结果 PCT组患者抗生素使用率(50.76%)显著低于对照组(78.03%),差异有统计学意义(P=0.000);PCT组抗生素平均使用时间短于对照组[(6.2±2.4)d vs(11.5±3.6)d],差异有统计学意义(P=0.000);PCT组患者平均住院天数相比对照组更短,差异有统计学意义(P=0.000)。PCT组和对照组白细胞计数、二重感染发生率、呼吸机辅助通气例数、死亡率、临床治疗有效率差异均无统计学意义(P>0.05)。结论 PCT可作为指导AECOPD抗生素使用的一项重要指标,提高抗生素的合理使用,降低二重感染,减少住院时间。

Objective To investigate the changes of serum procalcitonin in the anti-infective therapy of acute exacerbation of chronic obstructive pulmonary disease(COPD),and to evaluate its clinical value in guiding the use of antibiotics.Methods A total of 264 patients with AECOPD admitted to our department from September 2013 to September 2016 were randomly divided into the PCT group and the control group,with 132 cases in each group.The patients in the control group were treated with antibiotics according to their clinical experience.PCT group according to the serum PCT levels of antibiotic therapy,antibiotics application level of PCT≥0.25 g/L,when the PCT level is<0.25μg/L when the discontinuation of antibiotics.The use of two groups were compared the rate of antibiotics and the use of time,hospitalization time,double infection,mechanical ventilation,mortality and clinical efficiency and other indicators.Results In group PCT,the antibiotic use rate(50.76%)was significantly lower than the control group(78.03%),the difference was statistically significant(P=0.000);The mean duration of antibiotic use in the PCT group was shorter than that in the control group[(6.2±2.4)d vs(11.5±3.6)d],The difference was statistically significant(P=0.000).The mean hospital stay in PCT group was shorter than that in control group,the difference was statistically significant(P=0.000).The PCT group and control group had no significant differences in white blood cell count,incidence of double infection,ventilatory-assisted ventilation,mortality and clinical treatment efficiency(P>0.05).Conclusion PCT can be used as a guideline for the use of AECOPD antibiotics as an important indicator to improve the rational use of antibiotics,reduce double infection and reduce hospital stay.