降钙素原检测对脑出血发热患者抗菌药物合理使用的临床意义  

Clinical significance of procalcitonin detection in the rational use of antimicrobial agents of patients with cerebral hemorrhage fever

作　　者：谢广超[1] 李琼[1] 蔡静月[1] 蔡杰[1] 梁宇航[1] 

机构地区：[1]广东省湛江中心人民医院临床药学室,广东湛江524037

出　　处：《实用药物与临床》2016年第10期1265-1268,共4页Practical Pharmacy and Clinical Remedies

基　　金：湛江市科技计划项目(2015B01141)

摘　　要：目的研究降钙素原(PCT)检测对脑出血发热患者抗菌药物合理使用的临床意义。方法选取2013年5月至2015年4月我院脑系疾病中心收治的脑出血伴发热者240例,根据抽签法分为观察组和对照组,每组120例。对照组不参考PCT值予以抗菌药物治疗,观察组参考PCT值合理使用抗菌药物。记录观察组患者在治疗前,治疗后1、3、5、7、30 d的PCT动态值,观察两组患者的抗菌药物使用、住院及转归情况,比较两组患者治疗前后美国国立卫生研究院卒中量表(NIHSS)评分和日常生活能力(ADL)评分。结果抗感染治疗后,观察组患者在1、3、5、7、30 d的PCT水平分别为(18.23±2.01)、(14.34±1.87)、(7.24±1.12)、(3.43±0.34)、(0.87±0.04)μg/L,显著低于治疗前的(25.04±2.32)μg/L,差异有统计学意义(P<0.05)。观察组患者的抗菌药物使用率显著低于对照组(56.67%vs.86.67%),使用时间显著短于对照组[(9.32±1.23)d vs.(13.38±1.31)d],使用费用显著少于对照组[(2 573.21±142.15)元vs.(4 632.15±264.77)元],差异均有统计学意义(P<0.05)。观察组患者的住院总费用、住院时间显著少于对照组[(6 242.25±243.24)元vs.(8 321.55±754.36)元,(9.89±1.54)d vs.(11.38±1.31)d],差异均有统计学意义(P<0.05)。两组临床治愈率比较差异无统计学意义(90.0%vs.86.67%,P>0.05)。观察组和对照组治疗后的NIHSS评分和ADL评分比较差异均无统计学意义[(8.23±1.79)分vs.(8.67±1.83)分,(63.32±6.42)分vs.(62.34±6.39)分,P>0.05]。结论 PCT作为鉴别感染特别是细菌感染所致发热和非感染性发热的主要观察指标,为发热早期治疗时临床药师与医师设计或优化治疗方案、合理使用抗菌药物提供科学依据,值得在临床推广。Objective To study the clinical significance of procalcitonin（PCT） detection in the rational use of antimicrobial agents of patients with cerebral hemorrhage fever.Methods Totally 240 cases of cerebral hemorrhage complicated with fever from May 2013 to April 2015 in brain disease center of our hospital were divided into observation group and control group according to the draw method,120 cases in each group.Control group received antimicrobial therapy without depending on the reference value of PCT;observation group was rationally given antimicrobial therapy which depending on the reference PCT value.The dynamic value of PCT of observation group was recorded before and after 1,3,5,7 and 30 d of treatment.The antibacterial drug use,hospitalization and outcome of the two groups were observed,and the United States national institutes of health stroke scale（NIHSS） scores and ability of daily life（ADL） score of the two groups before and after treatment were compared.Results After anti-infection treatment,the PCT of observation group at 1,3,5,7 and 30 d was significantly lower[（18.23 ±2.01）,（14.34 ± 1.87）,（7.24 ±1.12） and（3.43 ±0.34）（0.87 ±0.04） μg/L vs.（0.87 ±0.04） μg/L],there being significant differences between the two groups（P 〈0.05）.The antimicrobial drug use of observation group was lower than that of control group（56.67%vs.86.67%）,and the time of medication was shorter[（9.32 ± 1.23） d vs.（13.38 ± 1.31） d],the cost was less[（2 573.21 ± 142.15） yuan vs.（4 632.15 ±264.77） yuan],the differences were significant（P 〈0.05）.The total hospitalization expenses and length of hospital stay of observation group were significantly less than those of control group[（6 242.25 ±243.24） yuan vs.（8 321.55 ±754.36） yuan,（9.89 ± 1.54） d vs.（11.38 ± 1.31） d],the differences being of statistical difference（P 〈0.05）.Clinical cure rate of the two groups showed no statistical difference（90.0%vs.86.67%,P 〉0.05）.After treatment,N

关 键 词：降钙素原 脑出血 发热 抗菌药物 

分 类 号：R743.34[医药卫生—神经病学与精神病学]