不同预防感染方案在肝硬化上消化道出血合并重度肝功能不全患者中的疗效观察

Abstract
Figure/Table
References (28)
Related Citation (15)

Download: PDF (518 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To study the effect of different infection prevention programs in the treatment of patients with liver cirrhosis and upper gastrointestinal bleeding with severe hepatic insufficiency. Methods From October 2018 to December 2019, a total of 60 patients in Wuxi No. 5 People’s Hospital, Jiangsu Province with liver cirrhosis and upper gastrointestinal bleeding who were admitted to the Intensive Care Unit and Child-Pugh graded as C were included. According to the random number table method, they were divided into the control group and the observation group, with 30 cases in each group. All patients were treated with conventional treatment for upper gastrointestinal bleeding of liver cirrhosis. At the same time, the control group was given third-generation cephalosporin, and the observation group was given β-lactamase inhibitor to prevent infection. The incidence of secondary infection, time of secondary infection, length of hospitalization, mortality, and rebleeding rate in the two groups were observed. Results The incidence of secondary infection in the observation group was lower than that of the control group, the time of secondary infection was later than that of the control group, and the length of hospitalization was shorter than that of the control group, the differences were statistically significant (all P ＜ 0.05). There were no statistically differences in the mortality and rebleeding rate between the two groups after the medication (all P ＜ 0.05). Among the 60 patients, secondary infection occurred in 17 cases, but non-secondary infection occurred in 43 cases. The rebleeding rate of secondary infected persons was higher than that of non-secondary infected persons, and the difference was highly statistically significant (P ＜ 0.01). Conclusion Choosing a relatively reasonable infection prevention treatment plan based on the evaluation of pathogenic bacteria, drug resistance, and its own special pathophysiological factors is positive for patients with liver cirrhosis and upper gastrointestinal bleeding to reduce the incidence of secondary infection, shorten the length of hospitalization, and reduce the rate of rebleeding.

Key words： Liver cirrhosis Upper gastrointestinal ble-eding Antimicrobial agent Preventive use Bacterial resistance

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	PAN Xiaojun1* LI Xiang2* GUAN Bin1 CAI Haifeng1

Cite this article:

PAN Xiaojun1* LI Xiang2* GUAN Bin1 CAI Haifeng1. Observation of curative effect of different infection prevention programs in patients with liver cirrhosis and upper gastrointestinal bleeding with severe hepatic insufficiency[J]. 中国医药导报, 2020, 17(32): 112-115.

URL:

http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2020/V17/I32/112

[1] 付万智，杨丽.抗菌药物用于预防肝硬化上消化道出血患者院内感染的临床效果观察[J].实用临床医药杂志，2015，19（11）：133-135.
[2] Yeong YL，Hoi-Poh T，Sanjiv M. Role of prophylactic antibiotics in cirrhotic patients with variceal bleeding [J]. World J Gastroenterol，2014，20（7）：1790-1796.
[3] 徐小元，丁惠国，贾继东，等.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].实用肝脏病杂志，2016，19（5）：641-656.
[4] 陈灏珠，林果为，王吉耀.实用内科学[M].14版.北京：人民卫生出版社，2013：2001-2003.
[5] 中国医师协会急诊医师分会.急性上消化道出血急诊诊治流程专家共识（修订稿）[J].中国急救医学，2011，31（1）：1-8.
[6] 中华医学会肝病学分会，中华医学会消化病学分会,中华医学会内镜学分会等.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].临床肝胆病杂志，2016，32（2）：203-219. doi:10.3969/j.issn.1001-5256.2016.02.002.
[7] 朱伟青，陈芝兰，黎红光.肝硬化上消化道出血医院感染患者预防性应用抗菌药物的观察[J].中华医院感染学杂志，2011，21（11）：2317-2319.
[8] Huang LY，Zhang B，Cui J，et al. Sequential therapy for patients with cirrhosis complicated by common bile duct stones and moderate to severe gastroesophageal varices [J]. Chin Med J，2012，125（23）：4312-4314.
[9] Tokai K，Miyatani H，Yoshida Y，et al. Multiple esophageal variceal ruptures with massive ascites due to myelofibrosis-induced portal hypertension [J]. World J Gastroenterol，2012，18（28）：3770-3774.
[10] 余小杰，吴云，肖丽娜.肝硬化上消化道出血医院感染患者预防性应用抗菌药物的观察[J].中华医院感染学杂志，2013，23（9）：2064-2066.
[11] 周国伟，陈晓丹.肝硬化上消化道出血预防应用抗菌药物的必要性研究[J].世界最新医学信息文摘：电子版，2018，18（15）：32-33.
[12] 刘莉.肝硬化上消化道出血患者预防性应用抗菌药物的临床观察[D].天津：天津医科大学，2015.
[13] 孙延娟，杨宗强，孙延龙.肝硬化患者肺部感染的相关因素分析[J].中国病原生物学杂志，2017，12（1）：76-78.
[14] 刘琳琳，袁术生，毛璟怡，等.肝硬化合并上消化道出血患者发生医院感染危险因素调查分析及预防策略[J].解放军医药杂志，2018，30（8）：49-53.
[15] 赵梅英，殷娟.住院患者肠杆菌科细菌感染分布及耐药率分析[J].陕西医学杂志，2016，45（7）：923-924.
[16] 程梅，褚少朋，张之烽，等.2017年江苏地区碳青霉烯类耐药肠杆菌科细菌的分布特点和耐药性分析[J].临床检验杂志，2018，36（9）：645-649.
[17] 谢雨苏，凌枫，包垚，等.社区卫生服务中心医院感染致病菌分布及耐药分析[J].医药前沿，2019，9（20）：68-70.
[18] 胡付品，郭燕，朱德妹，等.2018年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志，2020，20（1）：1-10.
[19] Hu FP，Guo Y，Zhu DM，et al. Resistance trends among clinical isolates in China reported from CHINET surveillance of bacterial resistance，2005-2014 [J].Clin Microbiol Infect，2016，22（Suppl 1）：S9-S14.
[20] Yin D，Dong D，Li K，et al. Clonal dissemination of OXA-232 carbapenemase-producing Klebsiella pneumoniae in neonates [J]. Antimicrob Agents Chemother，2017，61（8）：e00385-17.
[21] 国家卫生健康委员会.碳青霉烯类抗菌药物临床应用专家共识[S].北京：国家卫生健康委员会，2018.
[22] 李鑫，杨继勇.碳青霉烯类耐药肠杆菌科细菌分布与流行特征研究进展[J].中华微生物学和免疫学杂志，2019， 39（4）：306-310.
[23] Mairi A，Pantel A，Sotto A，et al. OXA-48-like carbapenemases producing Enterobacteriaceae in different niches [J]. Eur J Clin Microbiol Infect Dis，2018，37（4）：587-604.
[24] 宋双庆，马国杰，胡鹏飞.评价头孢哌酮钠他唑巴坦钠、哌拉西林钠舒巴坦钠、头孢他啶治疗急性胆囊炎的临床疗效和安全性[J].中国合理用药探索，2019，16（7）：26-28.
[25] 张菁，吕媛，于凯江，等.抗菌药物药代动力学/药效学理论临床应用专家共识[J].中华结核和呼吸杂志，2018， 41（6）：409-446.
[26] 陈佳，梅浙川.食管胃底静脉曲张出血预防性使用抗菌药物研究进展[J].重庆医学，2015，44（1）：125-127.
[27] 高晓东，胡必杰.从微生物层面思考提升我国医院感染防控的科学性[J].华西医学，2019，34（3）：223-226.
[28] 宗燕，金凌震.肝硬化合并上消化道出血发生院内感染状况及对策分析[J].浙江创伤外科，2018，23（6）：1108-1109.