摘要
目的了解抗生素治疗肝硬化并发社区及医院获得性自发性细菌性腹膜炎（SBP）患者的临床疗效及其影响因素。方法选取2010年8月至2014年3月被诊断为肝硬化合并SBP的384例患者，将其分成社区获得性和医院获得性。记录和分析所有患者的影响因素，并进行腹水细菌培养、鉴定。根据患者情况，分别采用头孢噻肟钠、头孢曲松钠、左氧氟沙星、哌拉西林他唑巴坦、亚胺培南西司他丁治疗并进行疗效判定。统计学方法采用卡方检验或Logistic回归分析。结果384例肝硬化合并SBP患者中，社区获得性SBP264例，医院获得性SBP120例。初治患者使用头孢噻肟钠、头孢曲松钠、左氧氟沙星的有效率分别为68．9％（62／90）、75．8％（72／95）、61．4％（51／83），低于哌拉西林他唑巴坦的93．1％（108／116），差异均有统计学意义（χ^2=20．600、12．490、30．190，P均〈0．01）。社区获得性SBP患者使用头孢噻肟钠、头孢曲松钠、左氧氟沙星的有效率分别为75．0％（48／64）、83．3％（50／60）、72．9％（35／48），分别高于医院获得性SBP患者的53．8％（14／26）、62．9％（22／35）、47．1％（16／34），差异均有统计学意义（χ^2=3．860、5．050、6．320，P均〈0．05）。社区和医院获得性SBP患者使用哌拉西林他唑巴坦的有效率分别为93．5％（86／92）和91．7％（22／24），差异无统计学意义（P〉0．05）。发病前3个月内使用抗生素和曾有住院史是头孢噻肟钠（χ^2=16．972、12．429）、头孢曲松钠（χ^2=20．564、5．764）、左氧氟沙星（χ^2=16．498、7．247）治疗无效的危险因素（P均〈0．05），合并糖尿病是头孢噻肟钠、头孢曲松钠治疗无效的危险因素（χ^2=7．427、6．087，P均〈0．05）。结论哌拉西林他唑巴坦治疗医院获得性SBP疗效较好；合并糖尿病、有抗生素使用史和住院史为治疗无效的危险因素。
Objective To investigate the therapeutic efficacy of antibiotics and influence factors in the treatment of patients with liver cirrhosis complicated with nosocomial-acquired and community-acquired spontaneous bacterial peritonitis （SBP）. Methods From August 2010 to March 2014, a total of 384 patients diagnosed with liver cirrhosis complicated with SBP were selected and divided into nosocomial- acquired and community-acquired groups. All the influence factors of patients were recorded and analyzed. Ascites was cultured and identified. According to the condition of patients, cefotaxime sodium, ceftriaxone sodium, levofloxacin, piperacillin-tazobactam, imipenem and cilastatin were administrated and the efficacy was determined. Chi square test or Logistic regression analysis was performed for statistical analysis. Results Among 384 patients with liver cirrhosis complicated with SBP, 264 were community-acquired SBP and 120 were nosocomial-acquired SBP. The efficacy rate of cefotaxime sodium, ceftriaxone sodium and levofloxacin in patients with initial treatment were 68.9% （62/90）, 75.8% （72/95） and 61.4% （51/83）, respectively; which was all lower than that of piperacillin tazobactam （93. 1%, 108/116）, and the differences were statistically significant （χ^2= 20. 600, 12. 490 and 30. 190, all P〈0. 01）. The efficacy rates of cefotaxime sodium, ceftriaxone sodium and levofloxacin in patients with community-acquired SBP were 75.0% （48/64）, 83.3% （50/60） and 72.9% （35/48） ,respectively, which was all higher than that in patients with nosocomial acquired SBP （53. 8%, 14/261 62. 9%, 22/35; 47. 1%, 16/34）, and the differences were statistically significant （χ^2=3. 860, 5. 050 and 6. 320, all P〈0.05）. The efficacy rates of piperacillin tazobactam in patients with community-acquired SBP and nosocomial-acquired SBP were 93.5% （86/92） and 91. 7% （22/24）, respectively, and the difference was not statistically significant （P〉0.05）. Antibiotics used in the recent three months before onset of the disease and hospitalization history were the risk factors of ineffective treatment of eefotaxime sodium （χ^2 = 16. 972 and 12. 429, both P〈0.05）, ceftriaxone sodium （χ^2=20. 564 and 5. 764, both P〈0.05） and levofloxacin （χ^2 =16. 498 and 7. 247, both P〈0.05）. Diabetes mellitus was the risk factor of ineffective treatment of cefotaxime sodium and ceftriaxone sodium （χ^2=7. 427 and 6. 087, both P〈0.05）. Conclusions For patients with nosocomial-acquired SBP, the efficacy of piperacillin-tazobactam was better. Diabetes mellitus, previous use of antibiotics and hospitalization history were risk factors of ineffective treatment.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2015年第10期673-677,共5页
Chinese Journal of Digestion
关键词
肝硬化
自发性细菌性腹膜炎
疗效
影响因素
Liver cirrhosis
Spontaneous bacterial peritonitis
Efficacy
Influence factor
