摘要
目的探讨血清降钙素原(PCT)动态监测在社区获得性肺炎(CAP)诊治综合评估中的作用。方法纳入我院呼吸科468例CAP住院患者,随机分成PCT指导组和标准指南组,动态比较两组临床症状、CURB-65评分、血白细胞数及分类、C反应蛋白(CRP)等指标,并且评估PCT指导下抗生素的使用时间、住院时间、胸部CT复查率、治愈/好转率等指标。结果与标准指南组比较,PCT指导组患者住院时间[(9.6±1.7)d比(10.9±1.6)d]、住院费用[(6 957.11±1 009.46)元比(8 011.35±1 049.77)元]、胸部CT复查率(56.96%比89.40%)、抗生素使用的时间[(16.5±2.3)d比(20.0±1.2)d]、抗生素升级治疗的比率(6.96%比11.06%)均低于对照组,两组差异有统计学意义(P<0.05);两组不良反应发生率(14.78%比15.20%)、转入ICU率(2.61%比3.69%)及死亡率(1.74%比2.30%)比较,差异无统计学意义(P>0.05)。结论在遵循CAP指南基础上,PCT动态监测可以缩短抗生素使用时间、住院时间,降低住院费用,减少胸部CT复查率。
Objective To investigate the role of dynamic monitoring procalcitonin( PCT) in the comprehensive evaluation during the diagnosis and treatment of community acquired pneumonia( CAP).Methods Four hundred and sixty-eight patients with CAP were randomly assigned to a PCT-guided group( the research group) and a standard guideline group( the control group). The clinical symptoms,CURB-65 grade,blood leucocyte count and classification,and C-reactive protein( CRP) were compared between two groups. The PCT-guided application time of antibiotics,the hospitalization time,chest CT examination rate,the cure or the improvement rate were also estimated and commpared. Results The hospitalization time[( 9. 6 ± 1. 7) days vs.( 10. 9 ± 1. 6) days],hospitalization cost [( 6 957. 11 ± 1 009. 46) yuan vs.( 8 011. 35 ± 1 049. 77) yuan],chest CT examination rate( 56. 96% vs. 89. 40%),the application time of antibiotics [( 16. 5 ± 2. 3) days vs.( 20. 0 ± 1. 2) days ],and the rate of required antibiotics upgrade( 6. 96% vs. 11. 06%) in the research group were all significantly lower than the control group( P < 0. 05).There was no significant difference between two groups in the ratio of the adverse reaction of antibiotics( 14. 78% vs. 15. 20%),the rate of transfer into ICU( 2. 61% vs. 3. 69%) or the mortality( 1. 74% vs.2. 30%)( P > 0. 05). Conclusion On the basis of CAP guidelines,the dynamic monitoring of PCT may shorten the time of antibiotic use and the hospitalization,reduce the cost of hospitalization and the rate of chest CT scan in patients with CAP.
出处
《中国呼吸与危重监护杂志》
CAS
北大核心
2015年第2期152-156,共5页
Chinese Journal of Respiratory and Critical Care Medicine
基金
上海市卫生局青年科研项目(编号:20114y112)
上海青年医师培养资助计划[编号:沪卫人事(2012)105号]
关键词
社区获得性肺炎
降钙素原
抗生素
胸部CT
Community acquired pneumonia
Procalcitonin
Antibiotics
Chest computed tomography
