美罗培南治疗肝硬化并发上消化道出血患者对感染预防和再出血的影响

Preventive application of meropenem in patients with liver cirrhosis complicated by upper gastrointestinal bleeding

目的探讨应用美罗培南(MEM)治疗肝硬化(LC)并发上消化道出血(UGB)患者对感染预防和再出血的影响。方法2016年11月~2018年10月期间我院重症医学科收治的92例LC并发UGB患者被随机分为对照组46例和观察组46例,在内科止血等综合治疗的基础上,分别在确定感染时再给予头孢曲松或在入院时即给予预防性应用MEM治疗。结果在治疗10 d,观察组死亡1例,对照组死亡2例;观察组WBC计数为(5.6±1.9)×109/L,血清降钙素原(PCT)水平为(0.25±0.03)ng/mL,显著低于对照组的(9.8±1.2)×109/L和(0.42±0.06)ng/mL,而血小板计数为(106.2±15.7)×109/L,显著高于对照组的(93.6±20.1)×109/L(P<0.05);观察组患者再出血率和感染发生率分别为8.9%和11.1%,均显著低于对照组的25.0%和43.2%,差异有统计学意义(P<0.05);观察组共检出8株菌株,对照组检出24株。两组感染患者均以大肠埃希菌感染为主,其次为肺炎克雷伯菌。结论预防性使用抗生素MEM治疗LC伴UGB患者能显著降低感染发生率,并对防止再出血有帮助,值得临床进一步验证。

Objective To investigate the preventive application of meropenem in patients with liver cirrhosis complicated by upper gastrointestinal bleeding(UGB).Methods 92 patients with liver cirrhosis complicated by UBG were admitted to the ICU of our hospital between November 2016 and October 2018,and were randomly divided into the control and the observation group,with 46 patients in each group.Patients in the control group didn’t received antimicrobial therapy until the infection was identified,and patients in the observation group were intravenously given prophylactic meropenem administration at presentation.Blood procalcitonin(PCT)level was assayed.Results At the end of ten day treatment,one patient in the observation and two in the control died;in survivals in the observation,the white blood cell count was(5.6±1.9)×109/L,and blood PCT level was(0.25±0.03)ng/mL,significantly lower than(9.8±1.2)×109/L and(0.42±0.06)ng/mL in the control,while the platelet count was(106.2±15.7)×109/L,significantly higher than(93.6±20.1)×109/L in the control(P<0.05);the re-bleeding rate and incidence of infection in the observation were 8.9%and 11.1%,both much lower than 25.0%and 43.2%,respectively,in the control(P<0.05);a total of 8 strains and 24 strains were separated in the observation group and in the control group,respectively,and the main infected bacteria was Escherichia Coli in the two groups,followed by Klebsiella pneumonia.Conclusion Prophylactic use of antibiotics is feasible in patients with liver cirrhosis complicated by UGB,which might significantly reduce the incidences of nosocomial infection and re-bleeding.