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目的研究血清降钙素原(PCT)测定在急性脑梗死后发热治疗中的作用。方法选取2005年9月至2007年11月年复旦大学附属上海市第五人民医院住院的急性脑梗死伴发热患者133例,分为常规治疗组66例(常规组)和PCT指导治疗组67例(PCT组)。常规组由经治医生按照抗生素使用指南决定抗生素治疗方案,PCT组按照血清PCT质量浓度决定是否使用抗生素。观察两组患者的住院时间、临床有效率、住院费用、抗生素费用、抗生素使用率以及治疗后28d病死率、美国国立卫生院卒中量表(NIHSS)评分和Barthel指数评分(BI)。结果两组患者在住院时间、临床有效率、治疗后28d病死率、NIHSS评分和BI指数方面比较,差异无统计学意义,PCT组的平均住院费用、抗生素费用及抗生素使用率[分别为6558(3774,9647)元、2673(1352,5287)元、70.1%]均低于常规组[分别为8373(4852,12533)元、4194(2869,7055)元、85.7%](均P<0.05)。结论急性脑梗死伴发热患者在PCT指导下使用抗生素,能够减少抗生素使用量,降低平均住院费用。
Objective To study the role of serum procalcitonin (PCT) in the treatment of fever after acute cerebral infarction. Methods A total of 133 acute cerebral infarction patients with fever who were hospitalized in Shanghai Fifth People’s Hospital affiliated to Fudan University from September 2005 to November 2007 were selected and divided into routine treatment group (66 cases) and PCT guidance group (67 cases) (PCT group). In the conventional group, the antibiotic treatment program was decided by the doctor in accordance with the guideline of antibiotic use. The PCT group decided whether to use the antibiotics according to the serum PCT concentration. The length of hospital stay, clinical efficacy, hospitalization costs, antibiotic costs, antibiotic use and mortality at 28 days after treatment were observed. NIHSS score and Barthel index score (BI) were compared between the two groups. Results There were no significant differences in hospitalization time, clinical efficiency, mortality at 28 days after treatment, NIHSS score and BI index between the two groups. The mean hospitalization expenses, antibiotic costs and antibiotic utilization rates in PCT group were 6558 ( 3774,9647) yuan, 2673 (1352,5287 yuan) and 70.1%] were lower than those in the conventional group [8373 (4852,12533 yuan, 4194 (2869,7055 yuan, respectively, 85.7% . Conclusion The use of antibiotics under the guidance of PCT in patients with acute cerebral infarction and fever can reduce the usage of antibiotics and reduce the average cost of hospitalization.