CAJ | 학술논문

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PCT<0.10μg/L，不予抗菌药物；B组（n=72）：发病时间<6 h内PCT<0.10μg/L或入院PCT为0.10~0.25μg/L，予观察，隔日检测PCT，若隔日PCT>0.25μg/L，治疗措施同C组；C组（ n=130）：入院PCT>0.25μg/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（P<0.05）。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%） PCT>0.25μg/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。
목적：탐토강개소원（PCT）수평검측대만성조새성폐질병（COPD）급성가중환자선용항균약물적지도개치，위COPD급성가중환자선용항균약물제공삼고。방법선취2012년1월—2014년2월재려수시련도구인민의원내과、급진종합과인COPD급성가중입원환자250례，입원후립즉검사PCT。안조PCT수평분위3조，A조（ n=48）：입원PCT<0.10μg/L，불여항균약물；B조（n=72）：발병시간<6 h내PCT<0.10μg/L혹입원PCT위0.10~0.25μg/L，여관찰，격일검측PCT，약격일PCT>0.25μg/L，치료조시동C조；C조（ n=130）：입원PCT>0.25μg/L，여항균약물치료，동시련속감측PCT，매천하강폭도≥30%설명항감염치료유효，PCT정상후정용항균약물；여과PCT하강폭도<30%，혹지속승고칙조정항균치료방안，병매일검측PCT。대비분석3조환자적림상자료、실험실검사지표급예후。결과3조환자적병사、림상증상、병정정도급실험실검사지표비교，차이균유통계학의의（P<0.05）。A조미여항균약물치료；B조여관찰，격일검측PCT，기중40례（55.6%） PCT>0.25μg/L자응용항균약물치료병정호전，32례（44.4%）<0.25μg/L자미응용항균약물；C조여항균약물치료，기중30례（23.1%）해수、해담、호흡곤난미호전，경개항균약물치료，최종122례예후교호，6례전상급의원，2례분별재주원제5、6천사망。결론 COPD급성가중환자PCT수평승고자염성반응급병정엄중，기층의원가의거PCT수평판단시부존재염성반응급병정정도，가이장PCT수평작위선용、경개항균약물혹평고항균약물료효적삼고공구。
Objective To investigate the guidance values of procalcitonin( PCT)in choosing antimicrobial drugs in a-cute exacerbation of elderly COPD. Methods From January 2012 to February 2014,in Liandu People Hospital,250 acute COPD patients had PCT after admission were divided into groups A(n=48,given PCT<0. 10μg/L without antibacterials at ad-mission),B(n=72,PCT<0. 1 μg/L within 6 h of onset or 0. 10-0. 25 μg/L at admission,PCT determined Alt. dieb;u-sing antibacterials if PCT>0. 25 μg/L Alt. dieb until normal PCT or adjusting antibiotic therapy),C( n=130,PCT>0. 25μg/L,using antibacterials if PCT>0. 25 μg/L Alt. dieb until normal PCT or adjusting antibiotic therapy). The indicators and results of laboratory examinations and prognosis were analyzed comparatively. Results There was significant difference in medi-cal history,clinical symptom,illness degree and indicators of laboratory examination between 3 groups( P<0. 05 ). Group A were not given antibacterials;in group B PCT detected Alt. dieb,40 patients with PCT>0. 25 μg/L improved after antibiotic therapy(55. 6%),32 with PCT<0. 25 μg/L were not given antibiotic therapy(45. 7%);in group C,antibiotic therapy were given,30 changed antibiotic therapy due cough,sputum,dyspnea with improvement,122 had good prognosis,6 transferred to high-level hospitals,2 died in days 5,6 after admission. Conclusion The acute COPD patients with high PCT level have in-flammatory response and are in serious condition. Primary hospitals can judge the existence of inflammatory response and disease severity according to PCT levels and take PCT as a reference tool for choosing,changing or evaluating the effects of antibacterial drugs.