摘要
目的探讨肝硬化上消化道出血患者接受预防性抗感染治疗失败的影响因素。方法回顾性分析2011年1月-2014年6月福建医科大学孟超肝胆医院收治的肝硬化上消化道出血患者82例,所有患者均接受三代头孢菌素预防性抗感染治疗7 d,观察抗感染治疗2周内的疗效,比较分析预防有效组和无效组之间临床特征的差异,计量资料组间比较采用t检验,计数资料组间比较采用χ2检验或Wilcoxon秩和检验。应用Logistic回归分析导致预防性抗感染失败的影响因素。结果 38例（46.4%）患者发生继发感染,预防有效组和预防无效组在凝血酶原时间、入住ICU的比例、入住ICU时间、接受深静脉穿刺的比例、Child-Pugh分级和Child-Pugh评分上比较差异均有统计学意义（P值均〈0.05）。Child-Pugh分级和入住ICU是预防性抗生素治疗失败的独立危险因素,比值比分别为2.455[95%可信区间（95%CI）：1.01～5.97,P=0.048]和4.12（95%CI：1.32～12.83,P=0.015）。结论三代头孢菌素预防性抗感染治疗失败率较高,入住ICU和高Child-Pugh分级是影响肝硬化上消化道出血预防性抗感染治疗失败的独立危险因素。
Objective To investigate the risk factors for antibiotic prophylaxis failure in patients with liver cirrhosis and upper gastrointesti- nal bleeding. Methods Eighty - two patients with liver cirrhosis and upper gastrointestinal bleeding who were admitted to our hospital from January 2011 to June 2014 were analyzed retrospectively. All paticnts received third - generation cephalosporins as the antibiotic prophylaxis for 7 days. The therapeutic effect of prophylaxis within two weeks was analyzed, and the clinical features were compared between prophylaxis response group and non - response group. The t - test or Mann - Whitney U test was applied for comparison of continuous data between groups, the chi - square test was applied for comparison of categorical data between groups, and the logistic regression analysis was applied to determine the risk factors for antibiotic prophylaxis failure. Results A total of 38 patients （46.4%） developed secondary infection. There were significant differences in prothrombin time, proportion of patients admitted to the intensive care unit （ ICU）, duration of ICU stay, proportion of patients who received deep venipuncture, Child - Pugh classification, and Child - Pugh score between the prophylaxis re- sponse group and non - response group （ P 〈 0.05 ）. Child - Pagh classification （ OR = 2.455, 95 % CI ： 1.01 - 5.97, P = 0.048 ） and ad- mission to the ICU （OR = 4.12, 95% CI ： 1.32 - 12.83, P = 0. 015 ） were the independent risk factors for antibiotic prophylaxis failure. Conclusion Antibiotic prophylaxis with third - generation cephalosporins has a high failure rate, and admission to the ICU and a high Child -Pugh classification are the independent risk factors for antibiotic prophylaxis failure.
出处
《临床肝胆病杂志》
CAS
2016年第2期288-291,共4页
Journal of Clinical Hepatology
基金
福州市卫生系统科技计划项目(2013-S-wq14
2013-S-W10)
关键词
肝硬化
胃肠出血
头孢菌素类
治疗
危险因素
liver cirrhosis
gastrointestinal hemorrhage
cephalosporins
therapy
risk factors
