相关指标变化对重症肺炎抗菌药物应用的指导意义

目的探讨动态监测C-反应蛋白(CRP)、降钙素原(PCT)在指导重症肺炎患者抗菌药物应用中的临床意义。方法 2014年1-12月将我院重症医学科(ICU)收治的68例重症肺炎患者采用随机数字表法分为试验组和对照组,每组34例。试验组以PCT≥0.5 ng/mL或CRP>10 mg/L结合实验室检查结果作为应用抗菌药物治疗的指征;对照组患者常规给予抗菌药物治疗。比较两组患者的治疗效果及相关指标差异。结果治疗前后两组的APACHEⅡ评分、WBC、PaO_2、SaO_2、PA、体温、CRP、PCT比较差异无统计学意义(P>0.05);治疗后,两组APACHEⅡ评分、WBC、体温、CRP、PCT均显著降低,PaO_2、SaO_2、PA显著升高(P<0.05)。试验组、对照组的住院时间分别为(21.4±3.5)、(25.5±2.9)d,抗菌药物应用时间为(14.7±4.6)、(19.8±6.3)d,住院费用为(33 826±3 025)、(42 043±4 416)元,抗菌药物费用(7 263±896)、(9 704±912)元,两组比较差异均有统计学意义(P<0.05)。两组患者的病死率、机械通气治疗时间比较差异无统计学意义(P>0.05)。结论动态监测CRP、PCT在指导重症肺炎患者抗菌药物应用中可以达到与常规应用抗菌药物治疗相当的效果,同时可以避免抗菌药物的过度应用,降低医疗费用,减轻患者的负担。

Guidance of changes in relevant indicators for the antibiotic use in patients with se-vere pneumonia

Objective To investigate the clinical significance of dynamic testing of C-reactive protein ( CRP) and procalcitonin ( PCT) in guiding the antibiotic use in patients with severe pneumonia. Methods Sixty-eight patients with severe pneumonia in Intensive Care Unit (ICU) of our hospital from January to December (2014) were divided into trial group and control group by random number table method,34 cases in each group. The antibiotics were used when PCT≥0. 5 ng/mL or CRP>10 mg/L in combination with other lab results in trial group. Regular antibiotic ther-apy was applied to patients of control group. The efficacy and the relevant indicators were compared between the two groups. Results There was no significant difference between the two groups in APACHE Ⅱ score, WBC, PaO2 , SaO2,PA,body temperature,CRP and PCT before and after treatment (P>0. 05). After treatment,the APACHE Ⅱscore,WBC,body temperature,CRP or PCT decreased significantly,while PaO2,SaO2 and PA increased (P<0. 05);no significant difference was found between the two groups ( P >0. 05 ) . The hospital stay and duration of antibiotic treatment in trial group was ( 21. 4 ± 3. 5 ) d and ( 14. 7 ± 4. 6 ) d, which were shorter than those of control group (25.5 ±2.9) d,(19.8 ±6.3) d],and there being significant differences between the two groups (P <0.05);the hospitalization expense and cost of antibiotic treatment was (33 826 ± 3 025) and (7 263 ± 896) yuan,which was low-er than those of control group (42 043 ± 4 416),(9 704 ± 912) yuan)],and there being significant differences be-tween the two groups (P<0. 05). There was no significant difference between the two groups in mortality and mechan-ical ventilation time (P>0. 05). Conclusion Dynamic testing of CRP and PCT has the same efficacy as regular anti-biotic use in guiding the treatment of severe pneumonia,and it has the advantages of avoiding excessive antibiotic use, reducing the cost of medical care and relieving the burden of patients.