降钙素原在社区获得性肺炎中对抗生素疗程的指导价值

发布时间：2018-05-18 06:13

本文选题：社区获得性肺炎 + 降钙素原　；参考：《中国人民解放军医学院》2017年硕士论文

【摘要】：研究背景:在社区获得性肺炎患者中,国内外指南对抗生素治疗的疗程无明确规定,推荐也多是“专家共识”,而非循证医学证据。临床医师凭经验决定抗生素疗程的情况并不少见,常常造成抗生素使用时间偏长,住院时间延长,住院费用增加,并可能增加细菌耐药的产生,甚至增加院内感染的发生。血清降钙素原(Procalcitonin, PCT)是细菌感染的敏感指标,并与感染的严重程度和预后密切相关。探讨依据PCT的动态改变指导CAP抗生素治疗疗程具有重要临床意义。目的:通过回顾性病例对照研究,评估降钙素原对治疗社区获得性肺炎抗生素治疗疗程的指导价值。方法:在2014年7月至2016年10月在解放军总医院第一附属医院呼吸科及中日友好医院呼吸科住院的624例社区获得性肺炎患者中,对其中在入院24小时内测定血清PCT且高于正常值,并在住院第3、5、7天多次监测的202例进行回顾性分析,其中98例患者依据PCT指导抗生素的使用及终止(观察组),104例患者未依据PCT数值的变化指导及停用抗生素(对照组)。两组患者给予相同的其他辅助治疗,观察组通过血清PCT水平改变来指导抗生素的使用及终止,对照组根据医师临床经验、指南建议及结合患者症状使用及停止抗生素的治疗。比较两组抗生素使用时间、临床有效率、住院费用、抗生素费用、住院时间、30天复发率及病死率之间的差异。结果:观察组抗生素使用时间、患者住院费用、抗生素费用及住院时间与对照组相比均有下降,且差异有统计学意义,观察组患者临床有效率、30天复发率及病死率与对照组差异无统计学意义。结论:根据PCT水平指导社区获得性肺炎患者抗生素的使用及终止,可以减少抗生素使用时间,缩短住院时间,降低住院时间及抗生素治疗费用,并能达到有效治疗。30天肺炎复发率及死亡率并没有增加。
[Abstract]:Background: in patients with community-acquired pneumonia, the guidelines at home and abroad on the course of antibiotic treatment are not clearly defined, and the recommendations are mostly "expert consensus", rather than evidence-based medical evidence. It is not uncommon for clinicians to decide the course of antibiotic treatment by experience, which often results in the prolonged use of antibiotics, prolonged hospital stay, increased hospitalization costs, and may increase the production of bacterial drug resistance and even the occurrence of nosocomial infection. Serum procalcitonin (PCT) is a sensitive indicator of bacterial infection and is closely related to the severity of infection and prognosis. It is of great clinical significance to explore the course of antibiotic therapy for CAP based on the dynamic changes of PCT. Objective: to evaluate the guiding value of procalcitonin in the treatment of community acquired pneumonia by retrospective case-control study. Methods: from July 2014 to October 2016, 624 patients with community-acquired pneumonia were hospitalized in the respiratory department of the first affiliated Hospital of the PLA General Hospital and the Respiratory Department of the Sino-Japanese Friendship Hospital. The serum PCT was measured within 24 hours after admission and was higher than the normal value. A retrospective analysis was carried out on 202 patients who had been monitored several times on the 3rd 5th day of hospitalization. Among them, 98 patients were guided by PCT to use and terminate antibiotics. 104 patients in the observation group did not guide and stop using antibiotics according to the change of PCT value (control group). Two groups of patients were given the same other adjuvant therapy. The observation group guided the use and termination of antibiotics by changing the level of serum PCT. The control group recommended and combined with the symptoms of the patients to use and stop using antibiotics according to the physician's clinical experience. The differences of antibiotic use time, clinical efficiency, hospitalization cost, antibiotic cost, 30 days recurrence rate and mortality were compared between the two groups. Results: the time of antibiotic use, the cost of hospitalization, the cost of antibiotics and the length of hospitalization in the observation group were lower than those in the control group, and the difference was statistically significant. There was no significant difference in the recurrence rate and mortality between the observation group and the control group. Conclusion: according to the level of PCT to guide the use and termination of antibiotics in patients with community-acquired pneumonia can reduce the time of antibiotic use, shorten the length of hospitalization, reduce the hospitalization time and the cost of antibiotic treatment. There was no increase in the recurrence rate and mortality rate of pneumonia on day 30 after effective treatment.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.1

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