Yang Shih-Cheng, Chen Jen-Chieh, Tai Wei-Chen, Wu Cheng-Kun, Lee Chen-Hsiang, Wu Keng-Liang, Chiu Yi-Chun, Wang Jing-Houng, Lu Sheng-Nan, Chuah Seng-Kee
Division of Hepato-gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan.
Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University; College of Medicine, Kaohsiung, Taiwan.
PLoS One. 2014 May 2;9(5):e96394. doi: 10.1371/journal.pone.0096394. eCollection 2014.
The influential roles of antibiotic prophylaxis on cirrhotic patients with peptic ulcer bleeding are still not well documented. The purpose of this study is to clarify these influential roles and to identify the risk factors associated with rebleeding, bacterial infection and in-hospital mortality. A cross-sectional, chart review study was conducted on 210 cirrhotic patients with acute peptic ulcer hemorrhage who underwent therapeutic endoscopic procedures. Patients were divided into group A (with prophylactic intravenous ceftriaxone, n = 74) and group B (without antibiotics, n = 136). The outcomes were length of hospital days, prevention of infection, rebleeding rate and in-hospital mortality. Our results showed that more patients suffered from rebleeding and infection in group B than group A (31.6% vs. 5.4%; p<0.001 and 25% vs. 10.8%; p = 0.014 respectively). The risk factors for rebleeding were active alcoholism, unit of blood transfusion, Rockall score, model for end-stage liver disease score and antibiotic prophylaxis. The risk factors for infection were active alcoholism, Child-Pugh C, Rockall score and antibiotic prophylaxis. Rockall score was the predictive factor for in-hospital mortality. In conclusions, antibiotic prophylaxis in cirrhotic patients after endoscopic interventions for acute peptic ulcer hemorrhage reduced infections and rebleeding rate but not in-hospital mortality. Rockall score was the predictive factor of in-hospital mortality.
抗生素预防对肝硬化合并消化性溃疡出血患者的影响作用仍未得到充分记录。本研究的目的是阐明这些影响作用，并确定与再出血、细菌感染和住院死亡率相关的危险因素。对210例接受治疗性内镜手术的肝硬化急性消化性溃疡出血患者进行了一项横断面图表回顾研究。患者被分为A组（静脉注射头孢曲松预防，n = 74）和B组（未使用抗生素，n = 136）。观察指标为住院天数、感染预防情况、再出血率和住院死亡率。我们的结果显示，B组再出血和感染的患者比A组更多（分别为31.6%对5.4%；p<0.001和25%对10.8%；p = 0.014）。再出血的危险因素为酒精滥用、输血量、Rockall评分、终末期肝病模型评分和抗生素预防。感染的危险因素为酒精滥用、Child-Pugh C级、Rockall评分和抗生素预防。Rockall评分是住院死亡率的预测因素。总之，肝硬化患者急性消化性溃疡出血内镜干预后使用抗生素预防可降低感染和再出血率，但不能降低住院死亡率。Rockall评分是住院死亡率的预测因素。
