發(fā)布時(shí)間：2018-07-04 11:09

  本文選題：降鈣素原 + 肺疾病　； 參考：《中國(guó)全科醫(yī)學(xué)》2014年35期

【摘要】：目的探討降鈣素原(PCT)水平檢測(cè)對(duì)慢性阻塞性肺疾病(COPD)急性加重患者選用抗菌藥物的指導(dǎo)價(jià)值,為COPD急性加重患者選用抗菌藥物提供參考。方法選取2012年1月—2014年2月在麗水市蓮都區(qū)人民醫(yī)院內(nèi)科、急診綜合科因COPD急性加重入院患者250例,入院后立即檢查PCT。按照PCT水平分為3組,A組(n=48):入院PCT0.10μg/L,不予抗菌藥物;B組(n=72):發(fā)病時(shí)間6 h內(nèi)PCT0.10μg/L或入院PCT為0.10~0.25μg/L,予觀察,隔日檢測(cè)PCT,若隔日PCT0.25μg/L,治療措施同C組;C組(n=130):入院PCT0.25μg/L,予抗菌藥物治療,同時(shí)連續(xù)監(jiān)測(cè)PCT,每天下降幅度≥30%說明抗感染治療有效,PCT正常后停用抗菌藥物;如果PCT下降幅度30%,或持續(xù)升高則調(diào)整抗菌治療方案,并每日檢測(cè)PCT。對(duì)比分析3組患者的臨床資料、實(shí)驗(yàn)室檢查指標(biāo)及預(yù)后。結(jié)果 3組患者的病史、臨床癥狀、病情程度及實(shí)驗(yàn)室檢查指標(biāo)比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。A組未予抗菌藥物治療;B組予觀察,隔日檢測(cè)PCT,其中40例(55.6%)PCT0.25μg/L者應(yīng)用抗菌藥物治療病情好轉(zhuǎn),32例(44.4%)0.25μg/L者未應(yīng)用抗菌藥物;C組予抗菌藥物治療,其中30例(23.1%)咳嗽、咳痰、呼吸困難未好轉(zhuǎn),更改抗菌藥物治療,最終122例預(yù)后較好,6例轉(zhuǎn)上級(jí)醫(yī)院,2例分別在住院第5、6天死亡。結(jié)論 COPD急性加重患者PCT水平升高者炎性反應(yīng)及病情嚴(yán)重,基層醫(yī)院可依據(jù)PCT水平判斷是否存在炎性反應(yīng)及病情程度,可以將PCT水平作為選用、更改抗菌藥物或評(píng)估抗菌藥物療效的參考工具。
[Abstract]:Objective to investigate the value of calcitonin (PCT) level detection for patients with acute exacerbation of chronic obstructive pulmonary disease (COPD), and to provide reference for the selection of antibiotics for acute exacerbation of COPD. Methods selected from January 2012 to February 2014 in the internal medicine of the people's Hospital in Liandu District, Lishui, the acute exacerbation of the emergency comprehensive comic COPD was admitted to hospital. 250 patients, immediately after admission, PCT. was divided into 3 groups, group A (n=48): PCT0.10 mu g/L, no antibiotics, B group (n=72): 6 h PCT0.10 mu g/L or hospitalized PCT. Treatment, at the same time continuous monitoring of PCT, the daily decrease of more than 30% shows the effectiveness of anti infection treatment, PCT after normal antiseptic drugs, if the PCT decline of 30%, or continue to increase the adjustment of antimicrobial therapy, and daily PCT. comparison and analysis of the clinical data of 3 groups of patients, laboratory examination indicators and prognosis. Results of the 3 groups of patients with the history of the disease, the clinical history, the clinical history, the outcome of the case, the clinical history, the clinical history of the outcome of the 3 groups of patients, the clinical history, the clinical history, the clinical history, the clinical history, the clinical history of patients, the clinical history of the outcome of the outcome. The difference of bed symptoms, condition degree and laboratory examination indexes were statistically significant (P0.05) group.A was not treated with antibiotics; group B was observed and PCT was detected in the other day, 40 cases (55.6%) PCT0.25 mu g/L used antibacterial drugs to improve the condition, 32 cases (44.4%) 0.25 micron g/L were not used antibacterials; C group was treated with antibacterial drugs, 30 of them were treated with antibacterial drugs. Cases (23.1%) cough, phlegm, dyspnea did not improve, changes of antibiotics treatment, the final 122 cases had better prognosis, 6 cases were transferred to higher hospital, 2 cases died at 5,6 days in hospital respectively. Conclusion the inflammatory response and condition of the patients with increased PCT level in COPD acute exacerbation patients were serious, and the basic hospital could judge whether there was inflammatory reaction and disease course according to the level of PCT. The PCT level can be used as a reference tool for modifying antibiotics or evaluating the efficacy of antimicrobial agents.
【作者單位】： 浙江省麗水市蓮都區(qū)人民醫(yī)院內(nèi)科;上海市浦東新區(qū)周浦醫(yī)院重癥醫(yī)學(xué)科;浙江省麗水市蓮都區(qū)人民醫(yī)院全科醫(yī)學(xué)科;
【基金】：浙江省麗水市科技局2012年公益性技術(shù)應(yīng)用項(xiàng)目(2012JYZB10)——降鈣素原指導(dǎo)基層醫(yī)院社區(qū)呼吸道感染患者抗菌藥物合理應(yīng)用的研究
【分類號(hào)】：R563.9

【共引文獻(xiàn)】

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本文編號(hào)：2095874