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[目的]在社区内获得性肺炎的临床诊疗过程中,通过连续测定一系列的HSP水平,并与通常使用的感染监测指标,如体温、白细胞计数进行比较,观察其在CAP的诊断、疗效以及预后方面的价值。[方法]每天测定病人的体温、白细胞计数和HSP浓度。观察病人到CAP治愈、病情稳定转出ICU或死亡。[结果]根据预后对死亡组和存活组进行回顾性分析,发现抗菌治疗后HSP有4种反应模式:快反应、慢反应、无反应、双相反应。表现为快反应的病人和大部分慢反应的病人存活下来,无反应和呈双相反应的病人全部死亡。对存活组和死亡组进行比较,从d0到d7存活组病人的HSP水平和HSP比率表现为稳定的下降,而在死亡组呈持续的升高,差异有统计学意义。那些起始即给予合适抗菌药物治疗的病人预后明显好于那些起始选用抗菌药物不当的病人。[结论]①应用抗菌治疗后每日监测HSP浓度,在CAP早期即可判断出CAP病人的预后,这一指标好于体温和白细胞计数。②HSP比率的变化与病情的变化相关,HSP比率快速下降预示病情改善,并可缩短抗菌治疗时间;HSP比率无反应或呈双相反应时,提示预后不良。
[Objective] To evaluate the clinical efficacy of CAP in the community through continuous measurement of a series of HSP levels and the commonly used indicators of infection monitoring, such as body temperature and white blood cell count Prognostic value. [Method] The daily body temperature, white blood cell count and HSP concentration were measured. Observe the patient to CAP cure, stable condition out of the ICU or death. [Results] According to the prognosis of the death group and survival group were retrospectively analyzed, we found that there are four kinds of HSP after antimicrobial therapy response mode: fast response, slow response, no reaction, biphasic reaction. Patients who showed fast response and the majority of slow response survived, and all patients who did not respond and were biphasic died. The survivors and death groups were compared, the survival of patients from d0 to d7 HSP levels and HSP showed a steady decline in the death group showed a sustained increase, the difference was statistically significant. Those who started the treatment with appropriate antibiotics had a significantly better prognosis than patients who initially chose inappropriate antibiotics. [Conclusion] ①The daily monitoring of HSP concentration after antibacterial treatment can predict the prognosis of patients with CAP in the early phase of CAP, which is better than that of body temperature and white blood cell count. (2) The change of HSP ratio is related to the change of disease, and the rapid decrease of HSP ratio indicates the improvement of disease and shorten the time of antimicrobial treatment. When HSP ratio is unresponsive or biphasic, the prognosis is poor.