预防性抗生素应用对重症脑卒中急性期感染和预后的影响

Effects of Antibiotic Prophylaxis on Infection and Prognosis after Severe Stroke

目的探讨预防应用抗生素对重症脑卒中急性期感染和预后的影响。方法 165例病程24 h内的急性脑卒中患者随机分为试验组和对照组,试验组早期给予头孢呋辛钠3 g、甲硝唑0.5 g静脉滴注,每日2次,或莫西沙星0.4 g静脉滴注每日1次。监测体温、C-反应蛋白(CRP)、白细胞计数、胸片变化,主要终点为急诊期间感染,次要终点为急诊死亡和急性期预后。结果试验组感染率(P=0.58)、感染确诊时间(P=0.74)、急诊死亡率(P=1.00)和平均死亡时间(P=0.84)、体温(P=0.99)、CRP(P=0.37)、白细胞计数(P=0.51)、格拉斯哥昏迷评分(P=0.31)和急性生理和慢性健康状况评估(APACHE-Ⅱ)评分(P=0.28)均与对照组无显著性差异。结论预防应用抗生素不能降低急性脑血管感染率及严重程度,也不改善急性期预后。

Objective To investigate the effects of antibiotic prophylaxis on the incidence of infection and prognosis in acute phase after severe stroke. Methods 165 patients within 24 h from clinic onset were divided into the intervention group and control group. The interven- tion included cefuroxime＋metronidazole or moxifloxacin. The body temperature was continuously monitored, and the presence of infection was daily assessed with C-reactive protein （CRP）, leukocyte count, and bedridden X-ray. They were also assessed with Glasgow Coma Scale （GCS） and Acute Pathologic and Chronic Health Evaluation （APACHE）- ]]. Primary end points was incidence of infection; secondary end points included death and other clinical outcome. Results There was no difference between tow groups in infection rate （P=0.58）, inter- val until diagnosis of infection （P=0.74）, so as mortality （P=I.00） and interval of death （P=0.84）, body temperature （P=0.99）, CRP （P= 0.37）, leukocyte （P=0.51）, scores ofGCS （P=0.31） and APACHE-l] （P=0.28）. Conclusion Antibiotic prophylaxis works little to prevent in- fection and improve outcome in patients with acute stroke.