头孢曲松与头孢哌酮加舒巴坦用于急性胆管炎手术前后的疗效比较

Comparison of efficacy between ceftriaxone and cefoperazone plus sulbactam in peri-operative treatment of acute suppurative cholangitis

目的 比较头孢曲松和头孢哌酮加舒巴坦 (舒普深 )两种药剂在急性化脓性胆管炎患者行胆总管引流术前后 ,控制感染的临床疗效、胆汁细菌清除率和费用。方法 患者随机分为头孢曲松组 (R组 )和舒普深组 (S组 ) ,每组 95例。手术前分别静脉滴注头孢曲松 2g或舒普深 2g ,术后R组每天 1次 ,S组每天 2次。两组均同时用甲硝唑。结果 两组有效率均为 98 9% ( 94 / 95 ) ,但R组的感染症状累计残存率下降比S组快 ,Log Rankχ2 =6 790 1,P =0 0 0 92。胆汁细菌清除率 :术后第 3天R组为 :72 0 % ( 36 / 5 0 ) ,S 组为 4 1 3% ( 19/ 4 6 ) ,P =0 0 0 37(精确概率法 )。药费 :R组为S组的 1/ 2弱。结论 头孢曲松和舒普深控制感染的有效率相等 ,前者消除感染症状和清除胆汁中的细菌比后者快 。

Objective To compare the efficacy of ceftriaxone and that of cefoperazone plus sulbactam (sulperazon) in controlling infection, in scavenging bacteria from bile, and in their costs when treating acute suppurative cholangitis with choledochostomy.Methods Patients were randomly assigned to two groups: the ceftriaxone group (R-group, n=95) and sulperazon group (S-group, n=95). Before choledochostomy, both groups received one intravenous dose of the corresponding antibiotics: and 2 g ceftriaxnoe for the R-group, 2 g sulperazon, containing 1g cefoperazone and 1g sulbactam, for the S-group. After the operation, the patients in the R-group received ceftriaxone 2g i.v. q.d.; the patients in the S-group received sulperazon 2g i.v. b.i.d.. In addition, all patients in both groups received metronidazole 0.5g daily before and after the operation. The efficacy was evaluated by efficiency in controlling infection and the persisting days of symptoms due to infection, fever and leukocytosis; the persisting days was compared using the life table method to calculate the 'cumulative probability of persistence of symptoms (CPPS)'. The two groups were also compared in regards to their biliary bacterial clearance rates and the costs directly attributable to the antibiotics.Results The efficiency in controlling infection was 98.9% (94/95) in both groups. However, the CPPS of the R-group decreased more rapidly than that of the S-group,Log-Rankχ 2= 6.7901, P =0.0092. Biliary bacterial clearance rate on post-operative day 3 was 72.0%(36/50)for the R-group, 41.3%(19/46)for the S-group, P =0.0037. Cost directly attributable to the antibiotics were (1788.29±518.46 )yuan (RMB) for the R-group, and (3768.74±820.55) yuan for the S-group, F =395.51, P =0.0000. Conclusion Both ceftriaxone and sulperazon are effective in treating acute suppurative cholangitis when used before and after choledochostomy. Ceftriaxone is superior in expediting symptom relief and bacterial clearance from bile, and is more cost-effective.