CAJ | 학술논문

目的探讨动态监测降钙素原(PCT)浓度变化在急性脑卒中相关性肺炎(SAP)抗菌药物使用中的指导价值.方法 132例SAP患者被随机分对照组(常规治疗,64例)和观察组(PCT指导治疗,68例),对照组抗生素疗程依据我国抗生素使用指南;观察组应用抗生素5d后,当PCT浓度＜0.25μg/L时停止应用,当PCT浓度≥0.25 μg/L时继续应用.记录所有患者应用抗生素疗程与抗生素费用、住院时间与费用、临床治疗有效率、治疗后30 d病死率,并且测量患者NIHSS评分和Barthel指数评分.结果(1)两组患者在年龄、性别、高血压、冠心病、糖尿病、收缩压、入院NIHSS评分以及病原菌分布、抗生素应用上差异均无统计学意义(P均＞0.05).(2)治疗30 d后,观察组与对照组临床有效率[86.8％(59/68)与87.5％ (56/64)]、病死率[7.4％ (5/68)与7.8％ (5/64)]、NIHSS评分[(12.3±5.8)分与(11.7±4.5)分]和Barthel指数(60.9±22.3与58.7±21.6)差异均无统计学意义(P均＞0.05).观察组住院时间(20.1±5.1)d显著低于对照组(25.4±6.0) d(t =5.479,P＜0.01),观察组的住院费用(0.8±0.6)万元显著低于对照组(1.2±0.8)万元(t =3.262,P＜0.01),观察组使用抗生素时间(11.3±2.6)d显著低于对照组(14.4±3.1) d(t =6.238,P＜0.01);观察组抗生素费用(0.3±0.1)万元显著低于对照组(0.5±0.2)万元(t =7.331,P＜0.01).结论 PCT动态监测能够指导SAP抗生素的安全使用,缩短住院时间与抗生素时间,减少治疗费用.
목적 탐토동태감측강개소원(PCT)농도변화재급성뇌졸중상관성폐염(SAP)항균약물사용중적지도개치.방법 132례SAP환자피수궤분대조조(상규치료,64례)화관찰조(PCT지도치료,68례),대조조항생소료정의거아국항생소사용지남;관찰조응용항생소5d후,당PCT농도＜0.25μg/L시정지응용,당PCT농도≥0.25 μg/L시계속응용.기록소유환자응용항생소료정여항생소비용、주원시간여비용、림상치료유효솔、치료후30 d병사솔,병차측량환자NIHSS평분화Barthel지수평분.결과(1)량조환자재년령、성별、고혈압、관심병、당뇨병、수축압、입원NIHSS평분이급병원균분포、항생소응용상차이균무통계학의의(P균＞0.05).(2)치료30 d후,관찰조여대조조림상유효솔[86.8％(59/68)여87.5％ (56/64)]、병사솔[7.4％ (5/68)여7.8％ (5/64)]、NIHSS평분[(12.3±5.8)분여(11.7±4.5)분]화Barthel지수(60.9±22.3여58.7±21.6)차이균무통계학의의(P균＞0.05).관찰조주원시간(20.1±5.1)d현저저우대조조(25.4±6.0) d(t =5.479,P＜0.01),관찰조적주원비용(0.8±0.6)만원현저저우대조조(1.2±0.8)만원(t =3.262,P＜0.01),관찰조사용항생소시간(11.3±2.6)d현저저우대조조(14.4±3.1) d(t =6.238,P＜0.01);관찰조항생소비용(0.3±0.1)만원현저저우대조조(0.5±0.2)만원(t =7.331,P＜0.01).결론 PCT동태감측능구지도SAP항생소적안전사용,축단주원시간여항생소시간,감소치료비용.
Objective To investigate the guidance value of procalcitonin(PCT) dynamic measurement on antibiotics usage of patients with stroke associated pneumonia(SAP).Methods One hundred and thirty-two cases with SAP were randomly divided into control group(64 cases with regular treatment) and observation group (68 cases with procalcitonin dynamic monitoring treatment).The treatment course of antibiotics in control group was according to antibiotics guidelines in China.Patients in observation group were given antibiotics for 5 days,stopped if the level of PCT was less than 0.25 μg/L,and continued to take if the level of PCT was more than 0.25 μg/L.The information were recorded including periods and cost of antibiotics usage,the periods and costs of hospitalization,clinical efficacy,mortality on the 30th day.The score of Institutes of National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI) were measured.Results (1) There were no significant differences in terms of age,gender,hypertension rate,coronary heart disease rate,diabetes rate,systolic blood pressure,the score of NIHSS in admission,pathogen and antibiotics between two groups (P ＞ 0.05).(2) After 30 days treatment,there were no significant differences in terms of clinical efficacy(86.8％ (59/68) vs.87.5％(56/64)),mortality (7.4％ (5/68) vs.7.8％ (5/64)),the score of NIHSS ((12.3 ±5.8) vs.(11.7 ± 4.5)) and BI (60.9 ± 22.3 vs 58.7 ± 21.6) between observation group and control group (P ＞ 0.05).The periods of hospitalization in observation group was (20.1 ± 5.1) d,less than that of control group ((25.4± 6.0) d,t =5.479,P ＜ 0.01).The costs of hospitalization in observation group was (8 ± 6) thousand yuan,significant lower than that of control group ((12 ± 8) thousand yuan,t =3.262,P ＜ 0.01).The periods of antibiotics usage in observation group was (11.3 ± 2.6) d,less than that of control group ((14.4 ± 3.1) d,t =6.238,P ＜ 0.01).The costs of antibiotics in observation group was (3 ± 1) thousand yuan,significant lower than that of control group ((5 ± 2) thousand yuan,t =7.331,P ＜ 0.01).Conclusion PCT dynamic monitoring can guide the safe usage of antibiotics in SAP in terms of shortening the length of hospitalization,duration of antibiotics,and reducing the costs.