降钙素原对早发性卒中相关肺炎诊断及抗生素使用的指导作用

摘要

目的 探讨监测血清降钙素原(procalcitonin,PCT)对脑卒中患者早发性卒中相关肺炎(early-onset pneumonia,EOP)的诊断及合理使用抗生素的指导作用.方法 选取安徽省立医院急诊内科收治的急性脑卒中患者220例.入院时检测52例EOP及168例非EOP患者血浆PCT水平,其中52例EOP患者被随机分为两组:PCT监测组(27例)与非PCT监测组(25例),观察两组的住院时间、抗生素疗程及临床有效率.结果 入院即刻,EOP组PCT值[(0.83±0.42)ng/ml]明显高于非EOP组[(0.18±0.06)ng/ml],差异有统计学意义(P<0.01);且EOP组在确诊时复测PCT值[(1.83士0.71)ng/ml]明显升高,与入院即刻相比,差异有统计学意义(P<0.01).在EOP患者中,PCT监测组的住院时间、抗生素疗程方面均低于非PCT监测组(P<0.05).结论 PCT监测可能对脑卒中患者是否伴有肺炎具有一定的鉴别作用,同时能够对抗生素的合理使用起到指导作用.%Objective To observe the value of monitoring procalcitonin(PCT) in the diagnosis and guidance of antibiotic therapy for stroke patients with early-onset stroke-associated pneumonia (EOP).Methods 220 cases of acute stroke patients that admitted in the department of emergency internal medicine in Anhui provincial hospital were recruited.The serum level of PCT of two groups were detected:EOP group (n=52) and non-EOP group (n=168) ; patients of EOP group were divided into 2 groups: PCT-guided group (n=27) and non-PCT-guided group (n=25).Length of hospitalization,duration of antibiotics and clinical efficacy were observed.Results When patients were hospitalized,the serum level of PCT in EOP group [(0.83±0.42) ng/ml] was significantly higher than that of non-EOP group [(0.18±0.06) ng/ml] (P<0.01); At the time of diagnosis,the serum level of PCT [(1.83±0.71) ng/ml] of EOP group was significantly increased (P<0.01);the length of hospital stay and antibiotic duration in the PCT-guided group were lower than those in the non-PCT-guided group (P<0.05).Conclusions PCT monitoring not may play a role in the diagnosis of EOP patients,and also can guide the rational use of antibiotics.