血清降钙素原对合理应用抗菌药物治疗老年慢性肺源性心脏病急性加重期的指导作用

摘要

Objective To explore the role of serum procalcitonin (PCT) in the treatment of acute exacerbation of chronic pulmonary heart disease (CPHD).Methods 62 elderly patient with acute exacerbation of CPHD were selected and divided,according to the levels of potentially pathogenic microorganism (PPM) in sputum,into 2 groups:bacterial infection group (n=48) and non-bacterial infection group (n=14),and the bacterial infection group was further divided into 2 subgroups:PCT monitoring group (n=26) and routine treatment group (n=22);besides the routine treatment,PCT levels guided the application of antibiotics in PCT monitoring group while physicians administrated antibiotics according to their clinical experience;a comparative study was made among the 3 groups in clinical effective rate,antibiotic therapy,hospitalization duration and the occurrence of double infection.Results The time length of antibiotic application,the hospitalization duration and the occurrence of double infection in PCT monitoring group were shorter than those in the other 2 groups (P＜ 0.05)while no statistical difference was found between routine treatment group and non-bacterial infection group (P＞ 0.05);there existed no statistical difference in clinical effective rate among the 3 groups (P＞0.05).Conclusions PCT level is of guiding role in the treatment of acute exacerbation of CPHD in the elderly,which can reduce the application ratio of antibiotics,shorten the time length of application and cut down the occurrence of double infection.%目的 研究血清降钙素原(PCT)在慢性肺源性心脏病急性加重期(AECPHD)治疗中的作用.方法 选择老年AECPHD患者62例,根据痰中的呼吸道潜在病原菌(PPM)浓度将患者分为细菌感染组(n=48),无细菌感染组(n=14),其中细菌感染组再随机分为PCT监测亚组(n=26)和常规治疗亚组(n=22).在常规治疗基础上,PCT监测组根据PCT来指导抗生素使用,另外2亚组由医师经验性的决定抗生素使用,对比3组之间临床有效率、抗生素疗程、住院时间和二重感染的差异.结果 治疗后,PCT监测亚组在抗生素使用时间、住院天数和二重感染发生率均低于另外2组(均P＜0.05),常规治疗组与无细菌感染组之间的差异无统计学意义(P＞0.05).3组在临床有效率方面的差异无统计学差异(P＞0.05).结论 在老年AECPHD患者治疗过程中参照PCT水平可以降低抗生素使用率,缩短使用时间,减少二重感染发生.