降钙素原水平对老年慢性阻塞性肺疾病急性加重期选用抗菌药物的指导价值

发布时间：2018-07-04 11:09

本文选题：降钙素原 + 肺疾病　；参考：《中国全科医学》2014年35期

【摘要】：目的探讨降钙素原(PCT)水平检测对慢性阻塞性肺疾病(COPD)急性加重患者选用抗菌药物的指导价值,为COPD急性加重患者选用抗菌药物提供参考。方法选取2012年1月—2014年2月在丽水市莲都区人民医院内科、急诊综合科因COPD急性加重入院患者250例,入院后立即检查PCT。按照PCT水平分为3组,A组(n=48):入院PCT0.10μg/L,不予抗菌药物;B组(n=72):发病时间6 h内PCT0.10μg/L或入院PCT为0.10~0.25μg/L,予观察,隔日检测PCT,若隔日PCT0.25μg/L,治疗措施同C组;C组(n=130):入院PCT0.25μg/L,予抗菌药物治疗,同时连续监测PCT,每天下降幅度≥30%说明抗感染治疗有效,PCT正常后停用抗菌药物;如果PCT下降幅度30%,或持续升高则调整抗菌治疗方案,并每日检测PCT。对比分析3组患者的临床资料、实验室检查指标及预后。结果 3组患者的病史、临床症状、病情程度及实验室检查指标比较,差异均有统计学意义(P0.05)。A组未予抗菌药物治疗;B组予观察,隔日检测PCT,其中40例(55.6%)PCT0.25μg/L者应用抗菌药物治疗病情好转,32例(44.4%)0.25μg/L者未应用抗菌药物;C组予抗菌药物治疗,其中30例(23.1%)咳嗽、咳痰、呼吸困难未好转,更改抗菌药物治疗,最终122例预后较好,6例转上级医院,2例分别在住院第5、6天死亡。结论 COPD急性加重患者PCT水平升高者炎性反应及病情严重,基层医院可依据PCT水平判断是否存在炎性反应及病情程度,可以将PCT水平作为选用、更改抗菌药物或评估抗菌药物疗效的参考工具。
[Abstract]:Objective to investigate the value of calcitonin (PCT) level detection for patients with acute exacerbation of chronic obstructive pulmonary disease (COPD), and to provide reference for the selection of antibiotics for acute exacerbation of COPD. Methods selected from January 2012 to February 2014 in the internal medicine of the people's Hospital in Liandu District, Lishui, the acute exacerbation of the emergency comprehensive comic COPD was admitted to hospital. 250 patients, immediately after admission, PCT. was divided into 3 groups, group A (n=48): PCT0.10 mu g/L, no antibiotics, B group (n=72): 6 h PCT0.10 mu g/L or hospitalized PCT. Treatment, at the same time continuous monitoring of PCT, the daily decrease of more than 30% shows the effectiveness of anti infection treatment, PCT after normal antiseptic drugs, if the PCT decline of 30%, or continue to increase the adjustment of antimicrobial therapy, and daily PCT. comparison and analysis of the clinical data of 3 groups of patients, laboratory examination indicators and prognosis. Results of the 3 groups of patients with the history of the disease, the clinical history, the clinical history, the outcome of the case, the clinical history, the clinical history of the outcome of the 3 groups of patients, the clinical history, the clinical history, the clinical history, the clinical history, the clinical history of patients, the clinical history of the outcome of the outcome. The difference of bed symptoms, condition degree and laboratory examination indexes were statistically significant (P0.05) group.A was not treated with antibiotics; group B was observed and PCT was detected in the other day, 40 cases (55.6%) PCT0.25 mu g/L used antibacterial drugs to improve the condition, 32 cases (44.4%) 0.25 micron g/L were not used antibacterials; C group was treated with antibacterial drugs, 30 of them were treated with antibacterial drugs. Cases (23.1%) cough, phlegm, dyspnea did not improve, changes of antibiotics treatment, the final 122 cases had better prognosis, 6 cases were transferred to higher hospital, 2 cases died at 5,6 days in hospital respectively. Conclusion the inflammatory response and condition of the patients with increased PCT level in COPD acute exacerbation patients were serious, and the basic hospital could judge whether there was inflammatory reaction and disease course according to the level of PCT. The PCT level can be used as a reference tool for modifying antibiotics or evaluating the efficacy of antimicrobial agents.
【作者单位】：浙江省丽水市莲都区人民医院内科;上海市浦东新区周浦医院重症医学科;浙江省丽水市莲都区人民医院全科医学科;
【基金】：浙江省丽水市科技局2012年公益性技术应用项目(2012JYZB10)——降钙素原指导基层医院社区呼吸道感染患者抗菌药物合理应用的研究
【分类号】：R563.9

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