目的：探讨血清降钙素原（ PCT）动态值指导临床抗感染治疗策略在优化老年重症肺炎抗菌药物应用中的作用，为临床合理用药提供参考。方法：将126例老年重症肺炎患者以随机数字表法分为2组进行临床常规的感染指标筛查检查，PCT指导治疗组（ PCT组）63例患者根据PCT值制订优化的抗感染治疗方案，常规治疗组（对照组）63例患者根据临床症状、体征给予经验性抗感染治疗。分析2组患者PCT值、超敏C反应蛋白、白细胞计数的变化和抗菌药物的使用情况。结果：126例患者中，存活109例，死亡17例。2组患者在抗菌药物使用时间、使用比例、使用强度、抗菌药物费用及重症医学科（监护病房）住院时间等方面的差异均有统计学意义（ P均＜0.05）。结论：PCT值可作为评估老年重症肺炎抗菌药物治疗效果和感染严重程度的快速、可靠的诊疗指标，基于PCT动态值指导优化抗菌药物治疗策略的效果良好，能有效减少老年重症肺炎患者抗菌药物的使用，缩短抗菌药物疗程，降低抗菌药物费用，具有良好的操作性及可行性。%OBJECTIVE:To investigate the dynamic serum procalcitonin ( PCT )-based optimization of antibiotic use in elderly with severe pneumonia for clinical referene of rational use of drug.METHODS:126 elder patients with severe pneumonia were randomly divided into two groups to undergo clinical routine screening test for indicators of infection, 63 cases in PCT-guided treatment group ( PCT group ) received PCT-based optimized anti-infective therapeutic therapy, and another 63 cases in the conventional treatment group ( control group ) were treated with empiric anti-infective therapy based on clinical symptoms and signs.PCT value, high-sensitivity C-reactive protein, white blood cell count and antibiotic use in the two groups were followed.RESULTS: Of the total 126 cases, 109 survived and the 17 died.There were statistically significant differences between the two groups in terms of the duration of antibiotic use, the proportion of patients receiving antibiotics, the antibiotic use density, cost of antibiotics and the length of hospital ( ICU) stay ( P<0.05 for all) .CONCLUSIONS:PCT levels could be used as a rapid and reliable index to evaluate the treatment outcome and the severity of infection.PCT-based optimization of antibiotic use achieved satisfactory outcome in that it could effectively reduce antibiotic use in elderly patients with severe pneumonia, shorten the course of treatment and reduce the cost of antibiotics, furthermore, it has good operability and feasibility.
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