| Objective: Critical care division for the critically ill patients in intensive care unit of centralized treatment, elderly patients with too much,Heart failure in the high incidence of the elderly population,The lung infection can increase the body’s metabolic rate,To improve the myocardial oxygen consumption and increase the load on the heart, and pulmonary infection significantly increased the resistance of pulmonary circulation, will also increase the ventricular afterload, aggravate the degree of heart failure.Therefore, clinical diagnosis and identify requirements in patients with early acute heart failure complicated by lung infection.Because elderly patients with low immunity, early symptoms of infection is less, infectious index was not obvious, C reactive protein(CR-P) and white blood cell count(WBC) and other traditional indicators of poor sensitivity.Therefore, elderly heart failure complicated with pulmonary infection often no characteristic, mutual aggravation, difficult diagnosis.Routine detection of patients with pulmonary infection, often diagnosed according to symptoms, signs and imaging examination, bacterial culture. There are time consuming, expensive, limited by illness, not easy to perform, the sensitivity and specificity of the poor.The traditional inspection method, such as: blood test, X-ray and etc.Not effective in heart failure under the background of the existence of pulmonary infection resolution,Therefore, clinical go up to often based on experience with treatment with antibiotics, may cause the unreasonable application of antibiotics and infection increase, the extension of treatment time lost, so the empirical application of antibiotics or deteriorate the prognosis of patients with delayed diagnosis.PCT is a precursor of calcitonin, produced by the thyroid C cells in normal circumstances, the current PCT is considered to be the markers of inflammation model in differential diagnosis of infection, has better specificity and sensitivity, there is a bacterial infection after 3- 4 hours to detect plasma PCT study shows, 6 hours to rise sharply, and to maintain the level of plasma concentration in 24 hours.A positive correlation between PCT concentration and the severity of inflammation, and with the inflammation control and remission of the disease and to the normal level, so the PCT can also be used as a judgement of severity and prognosis and curative effect observation of the reliability index.In this study, first hospitalized, 3, 7,14 days as the time node, through the analysis of the dynamic evolution of the level of serum PCT, PCT in order to understand the severity and prognosis of clinical application value.To explore the value of serum procalcitonin(PCT) in antiinfection therapies in elderly patients with heart failure.Methods: one hundred and sixty-five hospitalized patients with elderly patients with heart failure fiom January 2013 to May 2014,The APACHE-II score of 15-30, echocardiography measured left ventricular ejection fraction(LVEF value) is not more than or equal to 50%,They were randomly assigned into two groups: stangard therapy group(n=85) and PCT-guided group(n=80).The patients were given the same supportive therapy, including noninvasive ventilator assisted breathing, strong heart, diuretic, reducing the load on the heart, prevent myocardial remodeling, correct electrolyte and acid-base imbalance.The conventional treatment group by the physician in charge according to the clinical symptoms and changes in antimicrobial use patients decision timing of drugs, and PCT guidance treatment group respectively at admission and after first, five,seventh and fourteen days of the detection of serum PCT level, PCT concentration and its change according to the usage of antibiotic drugs decision time:When PCT is greater than or equal to 0.5g/L is the use of antibacterial drugs; when PCT < 0.5g/L is disabled after admission antibiotics, checking blood routine test, C reactive protein(CRP), serum PCT(immunofluorescence), blood gas analysis(Pa O2 and Pa CO2) and cardiac function(EF, pro-BNP), and send sputum and secretion of the respiratory tract as the culture of bacteria.Patients in standard therapy group recerved antibiotics according to clinical symptoms, while patients in PCT-guided group received antibiotics according to serum PCT levels.The items of clinical efficacy,hospital mortality,length of hospitalization,costs of hospitalization and antibiotics,period of antibiotics treatment,rates of Pulmonary infection within 0.5 year were abserved and compared between two groups.Results:1 The baseline characteristics of the two groups of patients:Baseline demographic and clinical characteristics of the patients in the two groups were basically similar, no statistical difference in age, gender, disease duration, EF value, pro-BNP, WBC, CRP, Pa O2 and Pa CO2 difference(P > 0.05).2 Two groups of patients the etiology of judgment:In the group of patients with co cultured specimens of 123 cases(conventional treatment group and PCT guidance treatment group were 66 cases and 57 cases), 45 strains of bacteria were isolated, the total positive rate of bacteriological 36.5%. The positive rate of routine sputum bacteriology group was 39.4%(26/66), 40.4% in PCT group(23/57), two groups of pathogens distribution of no significant difference(P > 0.05).In this group of cases, both the conventional treatment group patients or PCT guidance treatment group patients, pathogen strains in the top 3 were Klebsiella pneumoniae, Bauman Acinetobacter and Pseudomonas aeruginosa.3 Among patients in this study,the difference in clinical efficacy(81.2%-82.3%),hospital mortality(5.9%-5.0%),or rate of exacerbation within 0.5 year(28.0%-25.0%),were not statistically significant between standard therapy group and PCT-guided group(P > 0.05).While costs of hospitalization(9652-6854 RMB yuan) and antibiotics(3646-2543 RMB yuan),antibiotics treatment duration( 16.7days-10.3days) and rate of superinfection(28.0%-25.0%)in PCT-guided group were significantly lower than that in standard therapy group(P<0.05).Conclusions: This study is based on 165 cases of elderly patients with congestive heart failure were randomized into two groups, through comparative study found that, although the clinical PCT guidance treatment group with efficiency, hospital mortality, pulmonary infection incidence time and half year follow-up showed no statistical significance(P > 0.05);But the PCT guidance for the treatment of patients with the average total cost of hospitalization, the duration of antibiotic, antimicrobial drug costs and double infection rate was significantly lower than the conventional treatment group(P < 0.05).It is suggested that serum PCT is an important indicator of bacterial infection, its diagnostic value is obviously superior to the traditional peripheral white blood cell count and classification and CRP, according to the serum level of PCT decided to use antibiotic, antibiotic efficacy evaluation and important index as discontinuation of antibiotics.Serum PCT level could be used to optimize the anti-infection therapies in elderly patients with heart failure,which may reduce antibiotic usage,To reduce the resistance,hospitalization expenses and superinfection risks. |
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