降钙素原水平对老年慢性阻塞性肺疾病急性加重期选用抗菌药物的指导价值

摘要

目的：探讨降钙素原（PCT）水平检测对慢性阻塞性肺疾病（COPD）急性加重患者选用抗菌药物的指导价值，为COPD急性加重患者选用抗菌药物提供参考。方法选取2012年1月—2014年2月在丽水市莲都区人民医院内科、急诊综合科因COPD急性加重入院患者250例，入院后立即检查PCT。按照PCT水平分为3组，A组（ n=48）：入院PCT<0.10μg/L，不予抗菌药物；B组（n=72）：发病时间<6 h内PCT<0.10μg/L或入院PCT为0.10~0.25μg/L，予观察，隔日检测PCT，若隔日PCT>0.25μg/L，治疗措施同C组；C组（ n=130）：入院PCT>0.25μg/L，予抗菌药物治疗，同时连续监测PCT，每天下降幅度≥30%说明抗感染治疗有效，PCT正常后停用抗菌药物；如果PCT下降幅度<30%，或持续升高则调整抗菌治疗方案，并每日检测PCT。对比分析3组患者的临床资料、实验室检查指标及预后。结果3组患者的病史、临床症状、病情程度及实验室检查指标比较，差异均有统计学意义（P<0.05）。A组未予抗菌药物治疗；B组予观察，隔日检测PCT，其中40例（55.6%） PCT>0.25μg/L者应用抗菌药物治疗病情好转，32例（44.4%）<0.25μg/L者未应用抗菌药物；C组予抗菌药物治疗，其中30例（23.1%）咳嗽、咳痰、呼吸困难未好转，更改抗菌药物治疗，最终122例预后较好，6例转上级医院，2例分别在住院第5、6天死亡。结论 COPD急性加重患者PCT水平升高者炎性反应及病情严重，基层医院可依据PCT水平判断是否存在炎性反应及病情程度，可以将PCT水平作为选用、更改抗菌药物或评估抗菌药物疗效的参考工具。%Objective To investigate the guidance values of procalcitonin( PCT)in choosing antimicrobial drugs in a-cute exacerbation of elderly COPD. Methods From January 2012 to February 2014,in Liandu People Hospital,250 acute COPD patients had PCT after admission were divided into groups A(n=48,given PCT<0. 10μg/L without antibacterials at ad-mission),B(n=72,PCT<0. 1 μg/L within 6 h of onset or 0. 10-0. 25 μg/L at admission,PCT determined Alt. dieb;u-sing antibacterials if PCT>0. 25 μg/L Alt. dieb until normal PCT or adjusting antibiotic therapy),C( n=130,PCT>0. 25μg/L,using antibacterials if PCT>0. 25 μg/L Alt. dieb until normal PCT or adjusting antibiotic therapy). The indicators and results of laboratory examinations and prognosis were analyzed comparatively. Results There was significant difference in medi-cal history,clinical symptom,illness degree and indicators of laboratory examination between 3 groups( P<0. 05 ). Group A were not given antibacterials;in group B PCT detected Alt. dieb,40 patients with PCT>0. 25 μg/L improved after antibiotic therapy(55. 6%),32 with PCT<0. 25 μg/L were not given antibiotic therapy(45. 7%);in group C,antibiotic therapy were given,30 changed antibiotic therapy due cough,sputum,dyspnea with improvement,122 had good prognosis,6 transferred to high-level hospitals,2 died in days 5,6 after admission. Conclusion The acute COPD patients with high PCT level have in-flammatory response and are in serious condition. Primary hospitals can judge the existence of inflammatory response and disease severity according to PCT levels and take PCT as a reference tool for choosing,changing or evaluating the effects of antibacterial drugs.