监测降钙素原对早发性卒中相关性肺炎抗生素使用的指导作用

摘要

目的 探讨动态监测血清降钙素原水平变化在老年早发性卒中相关性肺炎(EOP)抗生素使用中的指导作用. 方法 179例老年EOP患者被随机分2组:常规治疗组(88例)和降钙素原指导治疗组(91例),常规组按照我国抗生素使用指南决定抗生素疗程；降钙素原组患者在使用抗生素5d后,按照血清降钙素原＜0.25 μg/L时,停用抗生素；降钙素原≥0.25μg/L时,继续使用抗生素.观察2组患者的住院时间、抗生素疗程、住院费用、抗生素费用、临床有效率以及治疗后28 d病死率、美国国立卫生研究院卒中量表(NIHSS)评分和Barthel指数评分(BI). 结果 降钙素原组与常规组患者临床有效率(85.7％比86.3％)、治疗后28 d病死率(8.8％比7.9％)、NIHSS评分(四分位数)[10.1(7.8,16.2)比9.8(6.0,15.5)]和BI指数[60.1(42.5,82.3)比57.9(39.2,84.8)]比较,差异无统计学意义(均P＞0.05).降钙素原组的住院时间[19(10,38)d]、抗生素疗程[10(7,14)d]、住院费用[7532(4810,12116)元]及抗生素费用[3350(2052,6163)元]均低于常规组[分别为26(17,42)d,15(6,21)d,10355(6877,15421)元,5358(3089,8144)元,均P＜0.05]. 结论 动态监测降钙素原水平指导老年卒中合并EOP的抗生素使用安全,能够缩短抗生素疗程和住院费用.%Objective To evaluate the effects of serum procalcitonin (PCT)-guided antibiotic therapy in elderly patients with early-onset stroke-associated pneumonia (EOP).Methods Totally 179 eligible elderly patients with EOP were randomly devided into 2 groups:standard therapy group (standard group,n=88) and PCT-guided group (PCT group,n=91).Patients in standard group received antibiotics according to antibiotics guidelines in China by the treating physicians.Patients in PCT group were treated with antibiotics for 5 days,then the antibiotic treatment was based on serum PCT levels as follows:discouraged if PCT＜0.25 μg/L and encouraged if PCT≥0.25 μg/L.Length of hospitalization,duration of antibiotics,costs of hospitalization and antibiotics,clinical efficacy,andmortality,National Institutes of Health Stroke Scale (NIHSS) score and Barthel index (BI) on the 28th day were observed.Results There were no significant differences in clinical efficacy,mortality,NIHSS score and BI between the two groups on the 28th day [(85.7％ vs.86.3％),(8.8％ vs.7.9％),10.1 (7.8,16.2) vs.9.8 (6.0,15.5),60.1(42.5,82.3) vs.57.9 (39.2,84.8),respectively,all P＞ 0.05].The length of hospitalization,antibiotic duration,costs of hospitalization and antibiotics were lower in PCT group than in standard group [19 (10,38) d vs.26(17,42) d,10 (7,14) dvs.15 (6,21) d,3350 (2052,6163) yuanvs.10355 (6877,15421) yuan,7532 (4810,12116) yuan vs.5358 (3089,8144) yuan,respectively,all P＜0.05].Conclusions PCT guidance of antibiotic therapy is effective and safe for the treatment of early-onset stroke associated pneumonia in elderly patients.It can reduce the antibiotic duration and costs of hospitalization.