| 预防性应用抗生素对肝硬化合并上消化道出血患者的影响 |
| 投稿时间：2016-11-11 修订日期：2016-12-06 点此下载全文 |
| 引用本文：郭月平,崔巍.预防性应用抗生素对肝硬化合并上消化道出血患者的影响[J].医学研究杂志,2017,46(9):115-119,145 |
| DOI：
10.11969/j.issn.1673-548X.2017.09.031 |
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| 中文摘要:目的 探索肝硬化合并上消化道出血的患者是否需要按照Child-Pugh分数及肝硬化病因进行分层分析来评估预防性应用抗生素对医院感染率、6周再出血率及病死率的影响，探索各Child-Pugh分级及不同肝硬化病因的患者是否都需要预防性应用抗生素。方法 收集该类患者316例，按入院时是否预防性应用抗生素分为抗生素组与对照组，监测两组患者医院感染率、6周再出血率及病死率。结果 1抗生素组患者的感染率及6周再出血率更低；2按肝硬化病因将患者分为肝炎后肝硬化、酒精性肝硬化，结果发现，肝炎后肝硬化合并上消化道出血的患者抗生素组的感染率及6周再出血率更低；酒精性肝硬化合并上消化道出血的患者抗生素组的感染率及6周再出血率更低；3按Child-Pugh分级将患者分为A、B、C 3级，结果发现，Child-pugh A级的患者抗生素组与对照组感染率、6周再出血率及病死率比较，差异均无统计学意义（P>0.05）；Child-pugh B级的患者抗生素组的感染率、6周再出血率更低；Child-pugh C级的患者抗生素组感染率、6周再出血率更低。结论 肝硬化合并上消化道出血的患者预防性应用抗生素能降低患者的医院感染率及6周再出血率，建议此类患者入院时短期预防性应用抗生素；预防性应用抗生素的效果与肝硬化的病因无关，但与Child-Pugh分级有关，Child A级的患者医院感染率及6周再出血率、病死率均较低，预防性应用抗生素不能降低医院感染率改善患者预后，此类患者是否需要预防性应用抗生素需要进一步的研究。 |
| 中文关键词:肝硬化合并上消化道出血 医院感染 预防性 抗生素 |
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| Impact of Prophylactic Antibiotics in Cirrhotic Patients with Upper Gastrointestinal Hemorrhage |
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| Abstract:Objective We investigated whether cirrhotic patients with upper gastrointestinal hemorrhage should be stratified for antibiotic prophylaxis based on Child-Pugh scores and etiology, to estimate risks of nosocomial infection, six-week re-bleeding, and mortality, and whether antibiotics prophylaxis have equal effects on patients of all Child-Pugh classes and etiologies. Methods A total of 316 hospitalized patients of cirrhosis patients with upper gastrointestinal hemorrhage were analyzed. The patients were classified as antibiotic group and control group, according to the patients whether received antibiotic prophylaxis or not. The two groups were monitored nosocomial infection rates, six-week re-bleeding rates and mortality rates. Results (1)Antibiotic prophylaxis reduces rates of nosocomial infection, six-week re-bleeding. (2)According to the etiology, cirrhosis can be divided into viral cirrhosis (VC) group and alcoholic cirrhosis (AC) group. The nosocomial infection rates and six-week re-bleeding rates of the VC group were lower in the antibiotic group. The nosocomial infection rates and the six-week re-bleeding rates of the AC group were lower in the antibiotic group. (3)According to Child-Pugh classification, patients were divided into Child-Pugh class A, B, C three groups. Child-Pugh class A group:the nosocomial infection rates, six-week re-bleeding rates and mortality rates had no significant difference between the antibiotic group and control group.Child-Pugh class B group:the nosocomial infection rates and six-week re-bleeding rates were lower in the antibiotic group.Child-Pugh class C group:the nosocomial infection rates and six-week re-bleeding rates were lower in the antibiotic group. Conclusion Antibiotic prophylaxis reduces rates of nosocomial infection, six-week re-bleeding in cirrhosis patients with upper gastrointestinal hemorrhage, so the writer suggests short-term antibiotic prophylaxis. Antibiotics prophylaxis have equal effects on cirrhosis patients of different etiologies. While antibiotics prophylaxis have no equal effects on cirrhosis patients of all Child-Pugh classes. The nosocomial infection rates, six-week-rebleeding rates and mortality rates of Child-Pugh class A are low. The recommendation for routine antibiotic prophylaxis for this subgroup requires further evaluation. |
| keywords:Cirrhosis patients with upper gastrointestinal hemorrhage Nosocomial infection Prophylactic Antibiotic |
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