亚胺培南西司他丁钠降阶梯治疗肝硬化并自发性腹膜炎的临床效果

Clinical effect of Imipenem Cilastatin Sodium step-down treatment of liver cirrhosis complicated with spontaneous peritonitis

目的探讨亚胺培南西司他丁钠降阶梯治疗肝硬化并自发性腹膜炎的临床效果。方法选取2018年1月~2019年12月阳江市公共卫生医院收治的76例肝硬化并自发性腹膜炎患者作为研究对象,按照不同的抗感染方案分为对照组(n=38)与观察组(n=38)。对照组采用经验性抗感染方案治疗,观察组采用亚胺培南西司他丁钠降阶梯治疗方案,抗感染治疗5~7 d后,依据临床症状缓解情况及细菌学培养+药敏试验结果进行抗感染方案调整。比较两组的治疗有效率、临床症状(腹痛及腹部体征、体温)缓解时间及治疗前后血清降钙素原(PCT)、C-反应蛋白(CRP)水平变化情况。结果观察组治疗后的总有效率高于对照组,差异有统计学意义(P<0.05),临床症状(腹痛及腹部体征、体温)缓解时间短于对照组,差异有统计学意义(P<0.05)。两组治疗前的血清PCT、CRP水平比较,差异无统计学意义(P>0.05);两组治疗后的血清PCT、CRP水平低于治疗前,且观察组的PCT、CRP下降水平低于对照组,差异均有统计学意义(P<0.05)。结论对肝硬化并自发性腹膜炎患者,使用亚胺培南西司他丁钠降阶梯抗感染治疗,可更有效改善患者的临床症状及感染指标,提高临床疗效,值得临床推广应用。

Objective To explore the clinical effect of Imipenem and Cilastatin Sodium in the treatment of cirrhosis with spontaneous peritonitis.Methods A total of 76 patients with cirrhosis and spontaneous peritonitis admitted to Yangjiang Public Health Hospital from January 2018 to December 2019 were selected as objects of study.According to different anti-infection schemes,they were divided into the control group(n=38)and the observation group(n=38).The control group was treated with Empirical anti-infection scheme,and the observation group was treated with Amipenem and Cilastatin Sodium step-down therapy.After 5-7 days of treatment,the anti-infection regime would be adjusted according to the clinical symptoms and the results of bacteriological culture and drug sensitivity test.The treatment efficiency,remission time of clinical symptoms(abdominal pain,abdominal signs,body temperature)and the changes of serum procalcitonin(PCT)and C-reactiveprotein(CRP)levels before and after treatment were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group(P<0.05).The remission time of clinical symptoms(abdominal pain,abdominal signs,body temperature)was shorter than that of the control group,the difference was statistically significant(P<0.05).There were no significant differences in serum PCT and CRP levels between the two groups before treatment(P>0.05).The serum PCT and CRP levels of the two groups were lower after treatment than before treatment,the PCT and CRP levels of the observation group were lower than those of the control group,the differences were statistically significant(P<0.05).Conclusion For patients with cirrhosis of the liver and spontaneous peritonitis,the use of Imipenanthinestatin Sodium for step-down anti-infection treatment can improve the clinical symptoms and infection indicators of the patients more quickly and effectively,and improve the clinical efficacy,which is worthy of clinical promotion and application.