糖尿病合并肺部感染患者监测降钙素原指导抗感染治疗的临床应用价值

发布时间：2018-04-08 13:20

本文选题：糖尿病　切入点：肺部感染　出处：《中华医院感染学杂志》2017年11期

【摘要】：目的观察降钙素原(PCT)在糖尿病合并肺部感染患者病程不同时间点的动态变化规律,探讨PCT对患者疾病严重程度、预后判断及抗感染治疗中的临床应用价值。方法前瞻性纳入2013年1月-2016年12月医院内分泌科收治118例糖尿病合并肺部感染患者,随机分为常规治疗组58例和PCT指导治疗组60例;患者入院后常规检测血常规、CRP、动脉血气(监测PaO_2和PaCO_2),留取血及深部痰标本行细菌培养及药敏试验,应用t和χ~2检验比较两组患者的抗菌药物应用疗程、住院时间、二重感染率、住院病死率、临床有效率及半年内随访肺部感染再发生率有无差异。结果两组患者性别、年龄等人口统计学方面比较,差异无统计学意义;在WBC、CRP、PaO_2和PaCO_2等炎症及氧合指标上比较,差异无统计学意义;所纳入患者共分离出病原菌51株,总细菌学阳性率43.22%;两组患者临床有效率、住院病死率、半年随诊期肺部感染再发生率比较,差异均无统计学意义;PCT指导治疗组在抗菌药物应用疗程及二重感染率上比较,明显低于常规治疗组,差异有统计学意义(P0.05)。结论检测PCT有助于指导糖尿病合并肺部感染患者的抗菌药物使用,可作为评价抗菌药物时机、疗程及疗效的一项关键指标。
[Abstract]:Objective to observe the dynamic changes of procalcitonin (PCT) in patients with diabetes mellitus complicated with pulmonary infection at different time points, and to explore the clinical application value of PCT in patients' disease severity, prognosis and anti-infection treatment.Methods from January 2013 to December 2016, 118 patients with diabetes mellitus complicated with pulmonary infection were randomly divided into routine treatment group (n = 58) and PCT guidance treatment group (n = 60).After admission, the patients were routinely detected by routine blood test (CRP), arterial blood gas (PaO_2 and PaCO2C), blood samples collected from deep sputum and deep sputum for bacterial culture and drug sensitivity test. The course of treatment, hospitalization time, and double infection rate of antimicrobial agents were compared by t and 蠂 ~ 2 tests.There was no difference in hospital mortality, clinical effective rate and re-incidence of pulmonary infection in half a year.Results there was no significant difference between the two groups in terms of sex, age and other demographics, but there was no significant difference in inflammatory and oxygenation indexes such as PaCO_2 and PaCO_2, 51 strains of pathogenic bacteria were isolated from the patients.The positive rate of total bacteriology was 43.22.The clinical effective rate, hospital mortality and re-incidence rate of pulmonary infection in the two groups were not significantly different between the two groups in the course of antimicrobial use and the double infection rate.The difference was significantly lower than that in the routine treatment group (P 0.05).Conclusion Detection of PCT is helpful to guide the use of antimicrobial agents in patients with diabetes mellitus and pulmonary infection, and can be used as a key index to evaluate the timing, course of treatment and efficacy of antimicrobial agents.
【作者单位】：绍兴文理学院附属医院内科;
【基金】：浙江省医药卫生科技计划基金资助项目(2014KYB362)
【分类号】：R563.1;R587.1

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