重症医学科老年心衰患者监测血清降钙素原水平指导抗感染治疗的临床应用价值

目的 探讨血清降钙素原（PCT）水平在老年心衰患者抗感染治疗策略中的价值.方法 选取2013年1月至2014年2月本院住院的老年心衰患者共165例,随机分为常规治疗组（85例）和PCT指导治疗组（80例）.常规治疗组根据患者临床症状和病情变化决定抗菌药物的使用,而PCT指导治疗组根据患者血清PCT浓度决定抗菌药物的使用.观察两组患者的临床有效率、住院病死率、住院时间、住院总费用、抗菌药物疗程、抗菌药物费用、二重感染率以及半年随访期间肺部感染的发生率.结果 常规治疗组和PCT指导治疗组在临床有效率（81.2％ vs 82.5％）、住院病死率（5.9％vs 5.0％）、半年随访期间肺部感染的发生率（32.9％ vs 31.3％）等方面差异均无统计学意义（P值均＞0.05）;而PCT治疗组患者在住院总费用（5 854元vs 9 652元）、抗菌药物疗程（10.2 d vs 16.7 d）、抗菌药物费用（2 543元vs 3 646元）及二重感染率（2.5％vs 7.1％）等方面均低于常规治疗组（P值均＜0.05）.结论 老年心衰患者在PCT指导下使用抗菌药物,能减少抗菌药物使用量,降低住院费用,降低二重感染的发生率.

Clinical study between determination of procalcitonin and pulmonary infection in elderly patients with heart failure in critical-care medicine

Objective To explore the value of serum procalcitonin （PCT） in antiinfection therapies in elderly patients with heart failure.Methods One hundred and sixty-five elderly patients with heart failure hospitalized from January 2013 to February 2014 were randomly assigned into two groups：standard therapy group（n =85） and PCT-guided group （n =80）.Patients in standard therapy group recerved antibiotics according to clinical symptoms,while patients in PCT-guided group received antibiotics according to serum PCT level.The clinical efficacy,hospital mortality,length of hospitalization,costs of hospitalization and antibiotics,period of antibiotics treatment,incidence of pulmonary infection within 0.5 year were observed and compared between two groups.Results There was no statistical difference in clinical efficacy （81.2％ vs 82.5％）,hospital mortality （5.9％ vs 5.0％）,and incidence of pulmonary infection within 0.5 year （32.9 ％ vs 31.3 ％） between standard therapy group and PCT-guided group （all P ＞0.05）.The costs of hospitalization （5 854 yuan vs 9 652 yuan） and antibiotics （2 543 yuan vs 3 646 yuan）,antibiotics treatment duration （10.2 days vs 16.7 days） and rate of superinfection （2.5％ vs 7.1％） in PCT-guided group were lower than those in standard therapy group （all P ＜ 0.05）.Conclusions Serum PCT level could be used to optimize the anti infection therapies in elderly patients with heart failure,which may reduce antibiotic usage,hospitalization expenses,and superinfection risks.