以PCT指导的抗菌治疗策略在小儿肺炎中的应用效果  

Effect of PCT-guided Antibacterial Treatment Strategy in Children with Pneumonia

作　　者：刘晓娜[1] 刘洋[2] 王麟[3] 元熙哲[4] LIU Xiao-na;LIU Yang;WANG Lin;YUAN Xi-zhe(Department of Pediatrics,32183 Hospital of the People's Liberation Army,Baicheng,Jilin Province,137000 China;Department of Respiratory Medicine,32183 Hospital of the Chinese People's Liberation Army,Baicheng,Jilin Province,137000 China;Department of Laboratory Medicine,32183 Hospital of the People's Liberation Army,Baicheng,Jilin Province 137000 China;Affiliated to Yanbian University Department of Pediatrics,Yanji,Jilin Province,133000 China)

机构地区：[1]中国人民解放军第32183医院儿科,吉林白城137000 [2]中国人民解放军第32183医院呼吸科,吉林白城137000 [3]中国人民解放军第32183医院检验科,吉林白城137000 [4]延边大学附属医院儿科,吉林延吉133000

出　　处：《世界复合医学》2020年第4期16-19,共4页World Journal of Complex Medicine

摘　　要：目的分析以PCT(降钙素原)指导的抗菌治疗策略在小儿肺炎中的应用效果。方法纳入该院2017年3月—2019年3月收治的82例小儿肺炎患者,随机平均分为两组,对照组41例患者由医生根据实验室、X线、血常规检查结果予以抗生素治疗,观察组41例患者以PCT指导予以抗菌治疗,对比两组临床疗效、临床症状消失时间、血清IL-4、TNF-α、CRP水平、血清免疫因子水平、不良反应发生情况。结果观察组临床总有效率(95.12%)明显高于对照组(65.85%),差异有统计学意义(χ^2=11.182,P<0.05)。观察组发热、肺部湿啰音、咳嗽症状消失时间分别是(2.26±0.31)d、(4.16±0.28)d、(4.01±0.26)d,对照组分别是(3.28±0.46)d、(6.35±0.58)d、(6.95±0.44)d,观察组发热、肺部湿啰音、咳嗽症状消失时间均明显短于对照组,差异有统计学意义(t=11.774、21.773、36.834,P<0.05)。观察组治疗7 d后血清TNF-α、CRP、IL-4水平分别是(106.25±3.62)ng/L、(4.16±0.25)mg/L、(8.06±0.15)ng/L;对照组分别是(179.62±5.47)ng/L、(13.62±1.41)mg/L、(12.62±1.84)ng/L,观察组治疗7 d后血清TNF-α、CRP、IL-4水平均明显低于对照组,差异有统计学意义(t=71.622、42.300、15.816,P<0.05)。观察组治疗7 d后CD4+、CD4+/CD8+水平分别是(47.62±5.99)%、(1.71±0.16),对照组分别是(41.26±3.85)%、(1.31±0.11),观察组治疗7 d后CD4+、CD4+/CD8+水平均明显高于对照组,观察组治疗7 d后CD8+水平(25.14±1.02)%明显低于对照组(29.66±1.54)%,差异有统计学意义(t=5.719、13.191、15.668,P<0.05)。观察组不良反应发生率(4.88%)明显低于对照组(24.39%),差异有统计学意义(χ^2=6.248,P<0.05)。结论以PCT指导的抗菌治疗可有效减轻小儿肺炎患者临床症状及炎症反应,增强免疫功能,且不良反应较少。Objective To analyze the effect of antibacterial treatment strategies guided by PCT(procalcitonin)in children with pneumonia.Methods 82 pediatric pneumonia patients admitted to the hospital from March 2017 to March 2019 were randomly divided into two groups at random,and 41 patients in the control group were treated with antibiotics by doctors based on laboratory,X-ray,and blood routine examination results.Observation group of 41 patients were given antibacterial treatment under the guidance of PCT.The clinical efficacy,time to disappear of clinical symptoms,serum IL-4,TNF-α,CRP levels,serum immune factor levels,and adverse reactions were compared between the two groups.Results The total clinical effective rate in the observation group(95.12%)was significantly higher than that in the control group(65.85%),and the difference was statistically significant(χ^2=11.182,P<0.05).The fever,lung wetness,and cough symptoms disappeared in the observation group at(2.26±0.31)d,(4.16±0.28)d,(4.01±0.26)d,and the control group was(3.28±0.46)d,(6.35±0.58)d,(6.95±0.44)d,the time of fever,wet wheezing,and cough disappearing in the observation group were significantly shorter than those in the control group,the differences were statistically significant(t=11.774,21.773,36.834,P<0.05).The serum TNF-α,CRP,and IL-4 levels in the observation group after 7 d of treatment were(106.25±3.62)ng/L,(4.16±0.25)mg/L,and(8.06±0.15)ng/L;the control group were(179.62±5.47)ng/L,(13.62±1.41)mg/L,and(12.62±1.84)ng/L.The serum TNF-α,CRP,and IL-4 levels in the observation group were significantly lower than those in the control group after 7 d of treatment.All were statistically significant(t=71.622,42.300,15.816,P<0.05).The levels of CD4+,CD4+/CD8+after 7 d of treatment in the observation group were(47.62±5.99)%and(1.71±0.16),while those in the control group were(41.26±3.85)%and(1.31±0.11),respectively.The CD4+/CD8+levels were significantly higher than those in the control group,and the CD8+level(25.14±1.02)%in the observation grou

关 键 词：降钙素原 抗菌治疗 小儿肺炎 临床疗效 炎症反应 

分 类 号：R725.6[医药卫生—儿科]