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目的探讨血清降钙素原(PCT)动态监测在社区获得性肺炎(CAP)诊治综合评估中的作用。方法纳入我院呼吸科468例CAP住院患者,随机分成PCT指导组和标准指南组,动态比较两组临床症状、CURB-65评分、血白细胞数及分类、C反应蛋白(CRP)等指标,并且评估PCT指导下抗生素的使用时间、住院时间、胸部CT复查率、治愈/好转率等指标。结果与标准指南组比较,PCT指导组患者住院时间[(9.6±1.7)d比(10.9±1.6)d]、住院费用[(6 957.11±1 009.46)元比(8 011.35±1 049.77)元]、胸部CT复查率(56.96%比89.40%)、抗生素使用的时间[(16.5±2.3)d比(20.0±1.2)d]、抗生素升级治疗的比率(6.96%比11.06%)均低于对照组,两组差异有统计学意义(P<0.05);两组不良反应发生率(14.78%比15.20%)、转入ICU率(2.61%比3.69%)及死亡率(1.74%比2.30%)比较,差异无统计学意义(P>0.05)。结论在遵循CAP指南基础上,PCT动态监测可以缩短抗生素使用时间、住院时间,降低住院费用,减少胸部CT复查率。
Objective To investigate the role of serum procalcitonin (PCT) in the comprehensive evaluation of diagnosis and treatment of community-acquired pneumonia (CAP). Methods A total of 468 CAP inpatients admitted to Department of Respiratory Medicine of our hospital were enrolled in this study. They were randomly divided into two groups: clinical symptom, CURB-65 score, white blood cell count and classification, C-reactive protein (CRP) Evaluation of the use of PCT under the guidance of antibiotic time, hospital stay, chest CT review rate, cure / improvement rate and other indicators. Results Compared with the standard guideline group, the length of hospital stay in the PCT group was (9.6 ± 1.7) days (10.9 ± 1.6) days, and the cost of hospitalization was (6 957.11 ± 1 009.46) yuan (8 011.35 ± 1 049.77) yuan (56.96% versus 89.40%), duration of antibiotic use (16.5 ± 2.3 days vs 20.0 ± 1.2 days), and rates of antibiotic escalation (6.96% versus 11.06%) were lower in the control group than in the control group (P <0.05). The incidences of adverse reactions (14.78% vs 15.20%) and ICU rates (2.61% vs. 3.69%) and mortality rates (1.74% vs 2.30%) in the two groups were significantly different between the two groups , The difference was not statistically significant (P> 0.05). Conclusion Based on the CAP guidelines, dynamic monitoring of PCT can shorten the antibiotic use time, hospitalization time, reduce the cost of hospitalization and reduce the rate of chest CT examination.