动态监测老年重症肺炎患者血清降钙素原水平对抗菌药使用的影响

目的探讨动态血清降钙素原(PCT)水平对临床老年重症肺炎优化抗菌药使用的价值。方法 94例患者分成实验组和对照组,对照组予常规治疗,跟据患者临床症状体征选用抗菌药;试验组监测血清PCT水平、超敏C反应蛋白(hs-CRP)和白细胞计数(WBC)的变化,制订优化抗菌药方案。结果 94例患者中存活81例,死亡13例。死亡患者3、5、7 d的血清PCT和hs-CRP值均明显高于存活患者,差异有统计学意义(P<0.05)。试验组的抗菌药疗程、住院天数、抗菌药费、抗菌药使用强度(AUD)以及二重感染和药品不良反应(ADR)等指标均优于对照组,差异均有统计学意义(P<0.05)。结论 PCT动态值对临床老年重症肺炎优化抗菌药的使用有实用价值。

Dynamic monitoring serum procalcitonin levels on antibiotic use in elderly patients with severe pneumonia

Objective To explore the value of dynamic monitoring of serum procalcitonin （PCT） levels on opti-mization of antibiotic use in elderly patients with severe pneumonia. Methods We allocated 94 patients to be treat-ed with antimicrobial agents based on clinical symptoms and signs （control group, n=47） or monitoring of serum PCT levels, high-sensitivity C-reactive protein （hs-CRP） and changes in blood routine tests （experimental group, n=47）, for optimizing the antimicrobial drug regimen. Results Of 94 patients recruited, 81 survived and 13 succumbed. At days 3, 5 and 7, patients who succumbed were associated with markedly higher levels of serum PCT and hs-CRP than those who survived （both P〈0.05）. Experimental group yielded a shortened duration of antibiotic treatment and length of hospital stay, and reduced expenditure of antibiotics, antibiotic use density, superinfection and adverse drug reac-tions （all P〈0.05）. Conclusion Dynamic monitoring of PCT confers practical significance of optimize antibiotic use in elderly patients with severe pneumonia.