老年重症肺炎的动态降钙素原监测及降阶梯治疗的探讨  

Investigation of Procalcitonin Monitoring and Dynamic of De-escalation Therapy in Elderly Patients with Severe Pneumonia

作　　者：邓白荔 何清华[1] 周舍典[1] 蔡卓夫[1] 莫俊德[2] 黄云平[3] 

机构地区：[1]湛江中心人民医院药学部,广东湛江524037 [2]湛江中心人民医院重症医学科,广东湛江524037 [3]湛江中心人民医院细菌室,广东湛江524037

出　　处：《今日药学》2015年第6期439-442,共4页Pharmacy Today

基　　金：湛江市科技计划项目(2013B01144)

摘　　要：目的探讨老年重症肺炎（SP）动态降钙素原（PCT）监测及降阶梯治疗的价值。方法选取2013-01-2014-11本院呼吸内科重症加强护理病房（ICU）老年重症肺炎患者85例,随机分为PCT加降阶梯组、降阶梯组和对照组,并对3组的资料进行回顾性分析。结果 85例患者第0天的急性生理学与慢性健康状况II（APACHE II）评分、序贯器官衰竭估计（SOFA）评分、肺炎严重程度（PSI）评分均明显升高,且PCT及超敏C-反应蛋白（hs-CRP）均呈正态分布。患者治疗48 h后,PCT动态质量浓度变化下降最快达30%,其次hs-CRP为10%,而白细胞计数（WBC）无明显变化。PCT加降阶梯组的细菌清除率明显高于对照组（P〈0.05）和降阶梯组,其住院天数、抗菌药的使用率、抗菌药费、住院费、抗生素使用密度（AUD均）值、药物不良反应（ADR）发生率及二重感染发生率等指标均比对照组明显降低（P〈0.05）,也低于降阶梯组;而不适当抗菌治疗发生率明显下降（P〈0.01）。结论老年SP患者早期使用动态PCT检测和降阶梯治疗在临床具有一定的价值。OBJECTIVE To investigate the dynamic procalcitonin（ PCT） monitoring and de-escalation therapy value in elderly patients with severe pneumonia（ SP）. METHODS From January 2013 to November 2014,respiratory medical of elderly patients with severe pneumonia（85 cases） in intensive care unit（ ICU） of the hospital were selected and randomly divided into 3 groups： the PCT plus de-escalation therapy group,the de-escalation therapy group and the control group. Data of the 3 groups were retrospectively analyzed. RESULTS The patients（85 cases） of first zero days,their acute physiology and chronic health evaluation-II（ APACHEII） score,sequential organ failure assessment（ SOFA） score,pneumonia severity index（ PSI） score were significantly increased,and PCT and high-sensitivity C-reaction protein（ hs-CRP） showed a normal distribution. After 48 h of treatment,the PCT dynamic mass concentration of patients decreased change fastest to 30%,followed by hs-CRP 10%,and the white blood cell count（ WBC） did not change significantly. Among them,the bacterial clearance rate in PCT plus de-escalation therapy group was significantly higher than that of the control group（ P〈0. 05）. In the de-escalation therapy group,their the hospitalization days,the application rate of antibacterial drugs,the antimicrobial drug costs,hospital costs,the antibiotic use density（ AUD） average value,and adverse drug reactions（ ADR） incidence and incidence of super infection and other indicators significantly lower than those of the control group（ P〈0. 05）,also lower than those of the de-escalation therapy group; and the occurrence of inappropriate antimicrobial therapy rate decreased significantly（ P〈0. 01）. CONCLUSION In elderly patients with severe pneumonia early using dynamic PCT detection and de-escalation therapy in clinical application has some positive value.

关 键 词：老年重症肺炎 细菌感染 降钙素原 降阶梯治疗 抗菌药物 

分 类 号：R97[医药卫生—药品]