血清PCT动态监测指导老年肾衰竭合并肺感染患者抗生素治疗的临床价值

Clinical value of dynamic monitoring of serum procalcitoninfor guidingantibiotic therapy in elderly patients with renal failure and pulmonary infection

目的探讨血清降钙素原(PCT)动态监测指导老年肾衰竭合并肺感染患者抗生素治疗的临床价值。方法选择2017年4月—2020年6月连云港市第一人民医院收治的98例老年肾衰竭合并肺感染患者为研究对象,以随机数字表法分为对照组(n=49)和研究组(n=49)。对照组常规应用抗生素,研究组以血清PCT水平指导使用抗生素。比较两组患者入院时、入院第3天、第5天、第7天血清PCT、白细胞(WBC)及C反应蛋白(CRP)水平以及血氧饱和度(SaO_(2))、二氧化碳分压(PaCO_(2)),观察两组患者抗生素费用、抗生素使用时间、住院时间,随访3个月,记录两组患者死亡及二重感染情况。结果入院时、入院第3天,两组患者血清PCT、WBC及CRP水平对比无显著性差异(P>0.05),入院第3 d至入院第7 d,两组患者血清PCT、WBC及CRP水平均呈下降趋势(P<0.05),且研究组入院第5天、第7天血清PCT、CRP水平均比对照组低(P<0.05),而两组患者入院第5天、第7天血清WBC水平对比(P>0.05)。入院时、入院第3 d,两组患者SaO_(2)、PaCO_(2)对比(P>0.05),入院第3天至入院第7天,两组患者PaCO_(2)呈下降趋势(P<0.05),且研究组入院第5 d、第7 d PaCO_(2)均比对照组低(P<0.05),入院第3天至入院第7天,两组患者SaO_(2)呈下降趋势(P<0.05),且研究组入院第5天、第7天SaO_(2)均比对照组高(P<0.05)。研究组抗生素费用、死亡率、二重感染率比对照组低(P<0.05),研究组抗生素使用时间、住院时间比对照组短(P<0.05)。结论血清PCT动态监测可指导老年肾衰竭合并肺感染患者抗生素治疗方案,减少死亡率及二重感染率。

Objective To explore the clinical value of dynamic monitoring of serum procalcitonin(PCT)for guiding antibiotic therapy in elderly patients with renal failure and pulmonary infection.Methods A total of 98 elderly patients with renal failure and pulmonary infection who were admitted to the the First People's Hospital of Lianyungang City from April 2017 to June 2020 were selected as the research objects.They were divided into a control group(n=49)and a study group(n=49)by a random number table.The control group routinely used antibiotics,and the study group guided the use of antibiotics based on serum PCT levels.The levels of serum PCT,white blood cell(WBC)and C-reactive protein(CRP),blood oxygen saturation(SaO_(2))and carbon dioxide partial pressure(PaCO_(2))on admission and on the 3rd,5th,and 7th day of admission in the two groupswere compared.The cost of antibiotics,antibiotic use time,and hospital stay in the 2 groupswereobserved.Followed up for 3 months,the death and secondary infection of 2 groups were recorded.Results There was no significant difference in serum PCT,WBC and CRP levels between the two groups at the time of admission and on the 3rd day of admission(P>0.05).From the 3rd to the 7th day of admission,the serum PCT,WBC and CRP levels of the 2 groups showed a downward trend(P<0.05),and the serum PCT and CRP levels of the study group were lower than those of the control group on the 5th and 7th day of admission(P<0.05).Moreover,the serum PCT and CRP levels of the study group were lower than those of the control group on the 5th and 7th day after admission(P<0.05).There was no significant difference in the comparison of SaO_(2) and PaCO_(2) between the two groups at the time of admission and on the 3rd day of admission(P>0.05).From the 3rd day to the 7th day of admission,the PaCO_(2) of the 2 groups showed a downward trend(P<0.05),and the 5th and 7th dPaCO_(2) of the study group were lower than those of the control group(P<0.05).From the 3rd day to the 7th day of admission,the SaO_(2) of the 2 groups ward trend(P<0.05),and the SaO_(2) of the study group was higher than the control group on the 5th and 7th day of admission(P<0.05).The antibiotic cost,mortality,and double infection rate in the study group were lower than those in the control group(P<0.05),and the antibiotic use time and hospital stay in the study group were shorter than those in the control group(P<0.05).Conclusion Serum PCT dynamic monitoring can guide the antibiotic treatment plan of elderly patients with renal failure and pulmonary infection,and reduce the mortality and double infection rate.