CAJ | 학술논문

目的探讨动态监测血清降钙素原水平变化在老年早发性卒中相关性肺炎(EOP)抗生素使用中的指导作用. 方法 179例老年EOP患者被随机分2组:常规治疗组(88例)和降钙素原指导治疗组(91例),常规组按照我国抗生素使用指南决定抗生素疗程；降钙素原组患者在使用抗生素5d后,按照血清降钙素原＜0.25 μg/L时,停用抗生素；降钙素原≥0.25μg/L时,继续使用抗生素.观察2组患者的住院时间、抗生素疗程、住院费用、抗生素费用、临床有效率以及治疗后28 d病死率、美国国立卫生研究院卒中量表(NIHSS)评分和Barthel指数评分(BI). 结果降钙素原组与常规组患者临床有效率(85.7％比86.3％)、治疗后28 d病死率(8.8％比7.9％)、NIHSS评分(四分位数)[10.1(7.8,16.2)比9.8(6.0,15.5)]和BI指数[60.1(42.5,82.3)比57.9(39.2,84.8)]比较,差异无统计学意义(均P＞0.05).降钙素原组的住院时间[19(10,38)d]、抗生素疗程[10(7,14)d]、住院费用[7532(4810,12116)元]及抗生素费用[3350(2052,6163)元]均低于常规组[分别为26(17,42)d,15(6,21)d,10355(6877,15421)元,5358(3089,8144)元,均P＜0.05]. 结论动态监测降钙素原水平指导老年卒中合并EOP的抗生素使用安全,能够缩短抗生素疗程和住院费用.
목적 탐토동태감측혈청강개소원수평변화재노년조발성졸중상관성폐염(EOP)항생소사용중적지도작용. 방법 179례노년EOP환자피수궤분2조:상규치료조(88례)화강개소원지도치료조(91례),상규조안조아국항생소사용지남결정항생소료정；강개소원조환자재사용항생소5d후,안조혈청강개소원＜0.25 μg/L시,정용항생소；강개소원≥0.25μg/L시,계속사용항생소.관찰2조환자적주원시간、항생소료정、주원비용、항생소비용、림상유효솔이급치료후28 d병사솔、미국국립위생연구원졸중량표(NIHSS)평분화Barthel지수평분(BI). 결과 강개소원조여상규조환자림상유효솔(85.7％비86.3％)、치료후28 d병사솔(8.8％비7.9％)、NIHSS평분(사분위수)[10.1(7.8,16.2)비9.8(6.0,15.5)]화BI지수[60.1(42.5,82.3)비57.9(39.2,84.8)]비교,차이무통계학의의(균P＞0.05).강개소원조적주원시간[19(10,38)d]、항생소료정[10(7,14)d]、주원비용[7532(4810,12116)원]급항생소비용[3350(2052,6163)원]균저우상규조[분별위26(17,42)d,15(6,21)d,10355(6877,15421)원,5358(3089,8144)원,균P＜0.05]. 결론 동태감측강개소원수평지도노년졸중합병EOP적항생소사용안전,능구축단항생소료정화주원비용.
Objective To evaluate the effects of serum procalcitonin (PCT)-guided antibiotic therapy in elderly patients with early-onset stroke-associated pneumonia (EOP).Methods Totally 179 eligible elderly patients with EOP were randomly devided into 2 groups:standard therapy group (standard group,n=88) and PCT-guided group (PCT group,n=91).Patients in standard group received antibiotics according to antibiotics guidelines in China by the treating physicians.Patients in PCT group were treated with antibiotics for 5 days,then the antibiotic treatment was based on serum PCT levels as follows:discouraged if PCT＜0.25 μg/L and encouraged if PCT≥0.25 μg/L.Length of hospitalization,duration of antibiotics,costs of hospitalization and antibiotics,clinical efficacy,andmortality,National Institutes of Health Stroke Scale (NIHSS) score and Barthel index (BI) on the 28th day were observed.Results There were no significant differences in clinical efficacy,mortality,NIHSS score and BI between the two groups on the 28th day [(85.7％ vs.86.3％),(8.8％ vs.7.9％),10.1 (7.8,16.2) vs.9.8 (6.0,15.5),60.1(42.5,82.3) vs.57.9 (39.2,84.8),respectively,all P＞ 0.05].The length of hospitalization,antibiotic duration,costs of hospitalization and antibiotics were lower in PCT group than in standard group [19 (10,38) d vs.26(17,42) d,10 (7,14) dvs.15 (6,21) d,3350 (2052,6163) yuanvs.10355 (6877,15421) yuan,7532 (4810,12116) yuan vs.5358 (3089,8144) yuan,respectively,all P＜0.05].Conclusions PCT guidance of antibiotic therapy is effective and safe for the treatment of early-onset stroke associated pneumonia in elderly patients.It can reduce the antibiotic duration and costs of hospitalization.