预防性抗生素对失代偿期肝硬化并肺部CT炎性改变的临床研究

发布时间：2018-05-18 17:49

本文选题：失代偿期肝硬化 + 预防性抗生素　；参考：《福建医科大学》2014年硕士论文

【摘要】：目的:探讨预防性抗生素治疗对失代偿期肝硬化合并肺部CT炎性改变的影响及相关因素分析。方法:回顾性分析2008年1月~2013年9月失代偿期肝硬化合并肺部CT炎性改变的患者，其中常规治疗同时接受预防性抗生素治疗的患者（治疗组），仅常规治疗、未接受预防性抗生素治疗的患者（对照组），比较两组Child-Pugh评分、感染率等，并按年龄、性别、Child-pugh分级（B级：7-9分、C级：10-15分1)1:1的比例配对，比较肺部感染的发生率，分析其影响因素。采用SPSS13.0软件进行统计分析，P0.05表示差异有统计学意义。结果:根据纳入与排除标准，本研究共入组患者105例，其中治疗组35例，对照组70例。（1）两组在年龄、性别等方面无统计学差异（P均＞0.05）；（2)住院期间出现肺部感染25例，总感染率23.8%（治疗组8.6%，对照组31.4%），两组肺部感染发生率的差异有统计学意义(χ2=6.720，P=0.010)；(3)在Child-Pugh B/C级、INR或1.5、PLT或98×109/L、TBIL或54.4umol/L亚组分层中，显示在Child-Pugh C级、INR1.5、PLT98×109/L、TBIL54.4umol/L分层患者,治疗组出现肺部感染率明显低于对照组，差异有统计学意义（P均0.05）；(4)治疗组与对照组间平均住院日比较差异无统计学意义（P=0.587）,但在感染组与非感染组间平均住院日比较差异有统计学意义（P=0.022）；（5）logistic多因素分析结果提示预防性抗生素治疗是失代偿期肝硬化合并肺部CT炎性改变患者进展肺部感染的独立保护因素为：RR值0.095（95%CI：0.018~0.504，P=0.006）；（6）logistic多因素分析结果提示血清血乳酸是感染的重要相关因素：RR值0.328（95%CI：0.110~0.978，P=0.045）。结论:（1）失代偿期肝硬化合并肺部CT炎性改变患者预防性抗生素治疗可有效减少肺部感染发生率、减少平均住院日；（2）若存在Child-pugh C级、INR1.5、PLT98×109/L及TBIL54.4umol/L其中一项以上者，宜尽早行预防性抗生素治疗，以降低住院期间肺部感染的发生率。
[Abstract]:Objective: to investigate the effect of prophylactic antibiotic therapy on pulmonary CT inflammatory changes in decompensated cirrhosis. Methods: the patients with decompensated cirrhosis complicated with pulmonary CT inflammatory changes from January 2008 to September 2013 were retrospectively analyzed. Patients who were not treated with prophylactic antibiotics (control group, comparison of Child-Pugh score, infection rate, etc.) were matched according to age, Child-pugh grade B: 7-9, C: 10-15, 1: 1: 1. The incidence of pulmonary infection was compared and the influencing factors were analyzed. Using SPSS13.0 software to carry on statistical analysis P 0.05 indicated that the difference was statistically significant. Results: according to the criteria of inclusion and exclusion, there were 105 patients in this study, including 35 cases in the treatment group and 70 cases in the control group. There was no significant difference in age, sex and other aspects between the two groups (P > 0.05). The total infection rate was 23.8cm (the treatment group was 8.6 and the control group was 31.4g), and the difference between the two groups was statistically significant (蠂 ~ 2 ~ (6.720) P ~ (0.010) in the Child-Pugh B / C grade INR or 1.5 脳 10 ~ (9) L% TBIL or 98 脳 10 ~ (9) L / L TBIL or 54.4umol/L subgroup, it was shown in the Child-Pugh C grade INR 1.5 PLT98 脳 10 ~ 9% TBI 54.4 umolol / L stratification. The pulmonary infection rate in the treatment group was significantly lower than that in the control group. There was no significant difference in average hospitalization days between the treatment group and the control group, but there was significant difference between the infection group and the non-infection group. The results showed that prophylactic antibiotic therapy was an independent protective factor for progressive pulmonary infection in patients with decompensated cirrhosis with pulmonary CT inflammatory changes. The results of multivariate analysis indicated that the ratio of blood lactate in serum was an important factor related to infection: RR: 0.32895CIW 0.1100.978CIW 0.1100.978F0. 0455.The results of logistic multivariate analysis showed that the ratio of serum lactate was 0.32895CIW 0.1100.978and P0.045. Conclusion the prophylactic antibiotic therapy for decompensated cirrhosis with pulmonary CT inflammatory changes can effectively reduce the incidence of pulmonary infection and reduce the average hospitalization days. If there is Child-pugh C grade INR1.5 PLT98 脳 109 / L and one or more of TBIL54.4umol/L, Prophylactic antibiotics should be given as early as possible to reduce the incidence of pulmonary infection during hospitalization.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.2

【参考文献】