Yang Shih-Cheng, Wu Keng-Liang, Wang Jing-Hung, Lee Chen-Hsiang, Kuo Yuan-Hung, Tai Wei-Chen, Chen Chien-Hung, Chiou Shue-Shian, Lu Sheng-Nan, Hu Tsung-Hui, Changchien Chi-Sin, Chuah Seng-Kee
Division of Hepato-gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, 123, Ta-Pei Road, Niao-sung Hsiang, Kaohsiung, 833, Taiwan.
Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan.
Hepatol Int. 2013 Mar;7(1):257-67. doi: 10.1007/s12072-012-9378-z. Epub 2012 Jun 22.
All previous studies reported the benefit of antibiotic prophylaxis in cirrhotic patients with either a mixture of nonvariceal and variceal bleeding or variceal bleeding alone. Reports on sole peptic ulcers bleeding are lacking. We aimed to assess the effect of antibiotic prophylaxis in cirrhotic patients with peptic ulcer bleeding after endoscopic interventions and the risk factors associated with recurrent bleeding.
A cross-sectional retrospective chart review study was conducted on 148 cirrhotic patients with acute peptic ulcer hemorrhage who underwent therapeutic endoscopic procedures. Patients who received prophylactic intravenous ceftriaxone were classified as group A (n = 38) and those who did not receive antibiotics were classified as group B (n = 110). The outcomes were prevention of infection, length of hospital stay, time of rebleeding, and death.
More patients suffered from recurrent bleeding and infection in group B than those in group A (28.2 vs. 5.3 %; p = 0.003, and 26.4 vs. 10.5 %; p = 0.043, respectively). The risk factors associated with recurrent bleeding were being male (OR = 3.4; p = 0.024), those with advanced stage of cirrhosis with Child-Pugh's class C (OR = 3.8; p < 0.001), and those without antibiotic prophylaxis (OR = 8.9; p = 0.003). The observed 30-day survival was virtually identical for both groups (p = 0.279).
Antibiotic prophylaxis in cirrhotic patients after endoscopic interventions for acute peptic ulcer hemorrhage reduced infections and decreased rebleeding. Male gender, cirrhosis Child-Pugh's class C, and no antibiotic prophylaxis were independent predictors of recurrent bleeding. Further studies should be directed to explore ways to improve the overall outcome of these patients.
既往所有研究均报道了抗生素预防对伴有非静脉曲张性和静脉曲张性出血混合情况或仅伴有静脉曲张性出血的肝硬化患者有益。关于单纯消化性溃疡出血的报道尚缺乏。我们旨在评估内镜干预后抗生素预防对肝硬化消化性溃疡出血患者的效果以及与再出血相关的危险因素。
对148例接受内镜治疗的急性消化性溃疡出血的肝硬化患者进行了一项横断面回顾性图表审查研究。接受预防性静脉注射头孢曲松的患者被分类为A组（n = 38），未接受抗生素治疗的患者被分类为B组（n = 110）。观察指标为感染的预防、住院时间、再出血时间和死亡情况。
B组患者再出血和感染的发生率高于A组（分别为28.2%对5.3%；p = 0.003，以及26.4%对10.5%；p = 0.043）。与再出血相关的危险因素为男性（OR = 3.4；p = 0.024）、肝硬化晚期Child-Pugh C级患者（OR = 3.8；p < 0.001）以及未接受抗生素预防的患者（OR = 8.9；p = 0.003）。两组的30天观察生存率几乎相同（p = 0.279）。
急性消化性溃疡出血内镜干预后，对肝硬化患者进行抗生素预防可减少感染并降低再出血率。男性、肝硬化Child-Pugh C级以及未进行抗生素预防是再出血独立的预测因素。应开展进一步研究以探索改善这些患者总体预后的方法。
