动态检测降钙素原指导慢性阻塞性肺疾病急性加重期抗生素使用的探讨  

Dynamic detection of procalcitonin on the guidance of antibiotic use for AECOPD

作　　者：黄颂平[1] 许庆华[1] 蔡志明[1] 叶晓艺[1] 沈冰寒[1] HUANG Song-Ping XU Qing-hua CAI Zhi-ming YE Xiao-yi SHEN Bin-han(Dept of Respiratory Medicine, the First Hospital of Quanzhou, Quanzhou, Fujian 362000, Chin)

机构地区：[1]泉州市第一医院呼吸科,福建泉州3620000

出　　处：《临床肺科杂志》2017年第3期489-492,共4页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨动态检测血清降钙素原(PCT)指导慢阻肺急性加重(AECOPD)患者抗生素应用的价值。方法选择2013年3月至2015年5月入住我院的AECOPD患者104例,随机分为降钙原组(n=54)和常规治疗组(n=50)。在相同常规治疗的基础上,降钙原组在入院2小时内、第3、7和第10d检测PCT水平,根据血清PCT水平决定抗生素使用和停用,如血清PCT≥0.25ug/L时使用抗生素治疗,PCT<0.25ug/L不使用或停用抗生素。常规治疗组由经治医师按照临床症状和抗生素使用指南决定抗生素治疗,临床稳定48h后停用。主要观察指标为两组患者的抗生素使用率、抗生素使用时间、住院时间、临床有效率、二重感染以及随访1年期间慢阻肺再次急性加重发生率。结果降钙原组的抗生素使用率59.2%,明显低于常规治疗组84%(P<0.05);降钙原组抗生素使用时间(8.2±2.2)d,而常规治疗(11.4±2.4)d,两者差异有统计学意义(P<0.05);住院时间(9.6±2.4)d均低于常规治疗组(12.2±2.8)d,(P均<0.05)。两组二重感染的发生率分别为3.7%与18.0%(P<0.05),两组患者在临床有效率(85.2%和86.0%)、随访1年期间再次急性加重发生率方面差异无统计学意义(P>0.05)。结论 AECOPD患者入院之初和治疗过程中动态进行PCT水平检测以指导抗生素使用,能有效降低抗生素的不合理使用,减少二重感染。Objective To evaluate the value of serum procalcitonin （PCT） on antibiotics use in treatment of AECOPD. Methods From March 2013 to May 2015, 104 patients with AECOPD were selected, and they were ran- domly divided into the PCT group （ n = 54） and the conventional therapy group （ n = 50）. The PCT levels of all pa- tients were measured 2 hours, 3, 7 and 10 days after hospital admission. The use of antibiotics was based on PCT se- rum level, that was antibiotics treatment were applied with PCT level ≥0.25ug/L and was stopped when PCT 〈 0. 25ug/L, and the use of antibiotics was based on clinical symptoms of patients in the conventional treatment group. The main observation indexes included clinical efficacy, the rate of antibiotics use, the days of antibiotics use, hospi- tal mortality, double infection incidence and rate of exacerbation within 1 year. Results For patients in the PCT group, the ratio of antibiotics use was significantly lower than the conventional therapy group （59. 2% vs. 83.3% ） （ P 〈 0.05 ）, the days of antibiotics use were （ 8. 2 ± 2. 2 ） d, and （ 11.4 ± 2.4 ） d in the conventional therapy group （ P 〈 0. 05 ）. There were significant differences in days of hospitalization [ （9. 6 ± 2.4） vs （ 12. 2 ± 2. 8） ] and doub- le infection incidence （3.7% vs 18.0% ） （P 〈0. 05）, while there was no significant difference in clinical efficacy （ 85.2% vs 86.0% ）, and the rate of exacerbation within 1 year between the two groups. Conclusion PCT could be used in treatment of AECOPD for antibiotic use after hospital admission, and it can reduce the excessive use of antibi- otics, the double infection opportunities and hospitalization time.

关 键 词：降钙素原 肺疾病 慢性阻塞性 抗生素 

分 类 号：R563.9[医药卫生—呼吸系统]