动态血清降钙素原监测优化脑出血发热抗菌药治疗的作用(1)
【摘要】 目的：探讨动态血清降钙素原(PCT)监测在指导优化脑出血发热患者抗感染治疗中的作用，为临床合理用药提供参考。方法：选取2014年1月-2015年1月本院收治的脑出血伴发热患者68例作为研究对象，采用随机数字表法将所选患者分为两组，PCT指导治疗组(PCT组)34例根据PCT动态值确定抗菌药的使用，常规治疗组(对照组)34例则由临床医师根据患者临床情况、实验室检查给予经验性抗菌药治疗；以治疗后第28 天为研究终点，记录并比较PCT组患者PCT值的变化及两组患者抗菌药的使用情况。结果：PCT组血清PCT水平随着抗菌药的使用而逐渐下降；PCT组抗菌药的使用比例、使用强度(AUD)、费用及使用金额比例等方面与对照组比较差异均有统计学意义(P<0.05)。结论：根据PCT动态值指导抗菌药治疗策略可优化脑出血发热抗菌药的使用，有效减少抗菌药的使用强度及比例，降低抗菌药费用，对避免抗菌药的过度使用，减少细菌耐药具有指导意义。
【关键词】 血清降钙素原动态值； 脑出血； 发热； 抗菌药
, http://www.100md.com
【Abstract】 Objective： To discuss the effect of dynamic serum procalcitonin(PCT) monitoring on the optimization of antibacterials treatment in intracerebral hemorrhage fever patients and provide references for rational drug use in the clinical.Method：68 patients with intracerebral hemorrhage complicating pyrexia in our hospital from January 2014 to January 2015 were selected and randomly divided into two groups，34 cases in the PCT group were treated with antibacterial according to the dynamic serum procalcitonin(PCT)，34 patients in the control group were given experiential antibacterial treatment according to patients’ clinical situations and laboratorial examination.The survey conducted 28 days，PCT values of the PCT group and the usage of antibacterial in the two groups were recorded and contrasted.Result：Serum procalcitonin of the PCT group decreased gradually with the use of antibacterials.There were significant differences between the PCT group and the control group in the aspects of antibacterial usage ratio，antibacterial using density(AUD)，the costs of antibacterial and the percentage of the costs(P<0.05).Conclusion：Making antibiotic treatment strategy according to the dynamic procalcitonin valves can optimize the usage of antibacterials in the treatment of intracerebral hemorrhage，reduce the AUD，usage ratio and the costs of antibacterials.It presents instructive meaning for avoiding excessively using of antibacterials and reducing drug-fast of bacteria during treatment. 【Key words】 Procalcitonin dynamic values； Intracerebral hemorrhage； Fever； Antibacterial
, 百拇医药
First-author’s address：Central People’s Hospital of Zhanjiang，Zhanjiang 524037，China
doi：10.3969/j.issn.1674-4985.2015.21.015
脑出血(intracerebral hemorrhage，ICH)是常见的脑卒中类型，占首次卒中的10%～15%，起病急，病情变化快，致残致死率高。脑出血患者80%～90%在发病后或病程中出现发热，体温越高，卒中预后越差，卒中后发热与致残率和病死率增高关系密切[1]。卒中的神经损伤及预后与体温改变有关，发热与卒中后不良预后密切相关[1-2]。但发热原因很多，急性脑卒中患者可因肺部、泌尿系感染及压疮、导管相关性感染等导致细菌感染性发热，也可因颅内高压致中枢性发热、脱水热、出血后吸收热、病毒感染、再出血、疼痛等多种原因出现非细菌感染性发热，往往难以鉴别[3]。对于不同原因导致的脑出血发热的治疗方案截然不同，感染并不是导致临床上炎症表现的唯一原因，早期鉴别诊断发热原因对临床用药至关重要。血清降钙素原(procalcitonin，PCT)作为全身细菌感染的重要标志物，能特异性区分细菌感染和其他原因导致的炎症反应，已被广泛应用于各种感染性疾病的早期诊治，对临床合理使用抗菌药具有重要指导意义[4-7]。本研究探讨动态监测血清PCT值变化对指导脑出血患者发热抗感染治疗的作用，以期为临床合理使用抗菌药提供参考。, 百拇医药(黄文权等)
【关键词】 血清降钙素原动态值； 脑出血； 发热； 抗菌药
, http://www.100md.com
【Abstract】 Objective： To discuss the effect of dynamic serum procalcitonin(PCT) monitoring on the optimization of antibacterials treatment in intracerebral hemorrhage fever patients and provide references for rational drug use in the clinical.Method：68 patients with intracerebral hemorrhage complicating pyrexia in our hospital from January 2014 to January 2015 were selected and randomly divided into two groups，34 cases in the PCT group were treated with antibacterial according to the dynamic serum procalcitonin(PCT)，34 patients in the control group were given experiential antibacterial treatment according to patients’ clinical situations and laboratorial examination.The survey conducted 28 days，PCT values of the PCT group and the usage of antibacterial in the two groups were recorded and contrasted.Result：Serum procalcitonin of the PCT group decreased gradually with the use of antibacterials.There were significant differences between the PCT group and the control group in the aspects of antibacterial usage ratio，antibacterial using density(AUD)，the costs of antibacterial and the percentage of the costs(P<0.05).Conclusion：Making antibiotic treatment strategy according to the dynamic procalcitonin valves can optimize the usage of antibacterials in the treatment of intracerebral hemorrhage，reduce the AUD，usage ratio and the costs of antibacterials.It presents instructive meaning for avoiding excessively using of antibacterials and reducing drug-fast of bacteria during treatment. 【Key words】 Procalcitonin dynamic values； Intracerebral hemorrhage； Fever； Antibacterial
, 百拇医药
First-author’s address：Central People’s Hospital of Zhanjiang，Zhanjiang 524037，China
doi：10.3969/j.issn.1674-4985.2015.21.015
脑出血(intracerebral hemorrhage，ICH)是常见的脑卒中类型，占首次卒中的10%～15%，起病急，病情变化快，致残致死率高。脑出血患者80%～90%在发病后或病程中出现发热，体温越高，卒中预后越差，卒中后发热与致残率和病死率增高关系密切[1]。卒中的神经损伤及预后与体温改变有关，发热与卒中后不良预后密切相关[1-2]。但发热原因很多，急性脑卒中患者可因肺部、泌尿系感染及压疮、导管相关性感染等导致细菌感染性发热，也可因颅内高压致中枢性发热、脱水热、出血后吸收热、病毒感染、再出血、疼痛等多种原因出现非细菌感染性发热，往往难以鉴别[3]。对于不同原因导致的脑出血发热的治疗方案截然不同，感染并不是导致临床上炎症表现的唯一原因，早期鉴别诊断发热原因对临床用药至关重要。血清降钙素原(procalcitonin，PCT)作为全身细菌感染的重要标志物，能特异性区分细菌感染和其他原因导致的炎症反应，已被广泛应用于各种感染性疾病的早期诊治，对临床合理使用抗菌药具有重要指导意义[4-7]。本研究探讨动态监测血清PCT值变化对指导脑出血患者发热抗感染治疗的作用，以期为临床合理使用抗菌药提供参考。, 百拇医药(黄文权等)