CAJ | 학술논문

目的探讨在老年人呼吸机相关性肺炎(VAP)治疗中用降钙素原(PCT)水平来指导临床抗生素使用的价值.方法 50例老年VAP患者分为常规治疗组与PCT指导治疗组.常规治疗组按常规治疗方法使用抗生素进行治疗,PCT组通过检测血清PCT浓度来指导抗生素使用.比较两组抗生素使用时间、使用率以及抗生素治疗结束后两组患者炎性指标[白细胞、中性粒细胞、C-反应蛋白(CRP)]和临床肺部感染积分(CPIS)之间的差异.结果两组经治疗后,PCT组患者白细胞、中性粒细胞、CRP[(8.9±3.5)×109/L、0.62±0.04、(18.7±8.5)mg/L]与常规组[(9.4±3.7)×109/L、0.60±0.04、(21.6±6.0)mg/L]差异无统计学意义(t值分别为0.47、1.84、1.37,均P>0.05),但是PCT组CPIS[(4.0±1.4)分]明显低于常规治疗组[(4.7±1.0)分],差异有统计学意义(t=2.18,P<0.05).两组在治疗前后,各炎性指标中除白细胞计数外,中性粒细胞、CRP及CPIS均较治疗前明显降低;PCT组PCT值也较治疗前降低[(1.7±0.7)mg/L至(0.5±0.9)mg/L].同时,在抗生素使用时间上,常规组[(8.72±1.32)d]与PCT组[(5.17±0.72)d]相比,差异有统计学意义(t=11.96,P<0.01);抗生素使用率分别为95.2%和55.2%,差异有统计学意义(χ2=12.41,P<0.01),PCT组抗生素使用率明显低于常规组.结论在老年VAP患者治疗中参考PCT水平用药,可以在达到更好治疗效果的同时减少抗生素的使用.
목적 탐토재노년인호흡궤상관성폐염(VAP)치료중용강개소원(PCT)수평래지도림상항생소사용적개치.방법 50례노년VAP환자분위상규치료조여PCT지도치료조.상규치료조안상규치료방법사용항생소진행치료,PCT조통과검측혈청PCT농도래지도항생소사용.비교량조항생소사용시간、사용솔이급항생소치료결속후량조환자염성지표[백세포、중성립세포、C-반응단백(CRP)]화림상폐부감염적분(CPIS)지간적차이.결과 량조경치료후,PCT조환자백세포、중성립세포、CRP[(8.9±3.5)×109/L、0.62±0.04、(18.7±8.5)mg/L]여상규조[(9.4±3.7)×109/L、0.60±0.04、(21.6±6.0)mg/L]차이무통계학의의(t치분별위0.47、1.84、1.37,균P>0.05),단시PCT조CPIS[(4.0±1.4)분]명현저우상규치료조[(4.7±1.0)분],차이유통계학의의(t=2.18,P<0.05).량조재치료전후,각염성지표중제백세포계수외,중성립세포、CRP급CPIS균교치료전명현강저;PCT조PCT치야교치료전강저[(1.7±0.7)mg/L지(0.5±0.9)mg/L].동시,재항생소사용시간상,상규조[(8.72±1.32)d]여PCT조[(5.17±0.72)d]상비,차이유통계학의의(t=11.96,P<0.01);항생소사용솔분별위95.2%화55.2%,차이유통계학의의(χ2=12.41,P<0.01),PCT조항생소사용솔명현저우상규조.결론 재노년VAP환자치료중삼고PCT수평용약,가이재체도경호치료효과적동시감소항생소적사용.
Objective To explore the significance of the plasma procalcitonin (PCT) level for directing antibiotic therapy in elderly patients with ventilator-associated pneumonia (VAP).Methods The 50 elderly patients with VAP were randomly separated into the regular therapy group and the PCT-directed therapy group. The regular therapy group was given regular antibiotic therapy, while the antibiotic therapy was decided according to the plasma level of PCT in the PCT-directed therapy group. The used time and utilization rate of antibiotics, as well as inflammatory indicators including white blood cells, neutrophils, C-reactive protein (CRP) and clinical pulmonary infection score (CPIS) were compared between the two groups. Results After treatment, there were no significant differences in white blood cells, neutrophils and CRP between the PCT-directed therapy group and regular therapy group [(8.9 ± 3.5 ) × 109/L vs. (9.4 ± 3.7) × 109/L, 0.62 ± 0.04 vs.0.60±0.04, (18.7±8.5) mg/Lvs. (21.6±6.0) mg/L, t=0.47, 1.84 and 1.37, allP＞0.05],but the CPIS was markedly lower in PCT-directed therapy group than in regular therapy group [(4.0± 1.4) scores vs. (4.7± 1.0) scores, t= 2. 18, P＜0.05]. The neutrophils, CRP and CPIS were significantly lower after treatment than before in the both groups. The concentration of PCT was decreased after treatment than before [(0.5 ± 0.9) mg/L vs. (1.7 ± 0.7) mg/L]. Meanwhile, the time using antibiotics was longer in regular treatment group than in PCT-directed therapy group [(8.72±1.32) d vs. (5.17±0.72) d, t=11.96, P＜0.01], the utilization rate of antibiotics was higher (95.2 % vs. 55.2 %, χ2 = 12.41, P＜0.01) in regular treatment group. Conclusions Using PCT levels for directing treatment in elderly patients with VAP can achieve better curative effect and reduce the use of antibiotics.