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急性静脉曲张出血患者在内镜治疗后应用抗生素可预防再出血

心血管内科医师 · 最后编辑于 2022-10-09 · IP 湖北湖北
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这个帖子发布于 21 年零 109 天前,其中的信息可能已发生改变或有所发展。
细菌感染对胃食管静脉曲张出血(GEVB)患者的止血具有不良影响。预防性使用抗生素能够防止这些患者出现细菌感染,但尚未阐明该类药物防止再出血的效果。

台北退伍军人综合医院的Ming-Chih Hou博士及其同事在25个月内安排无细菌感染的急性GEVB患者随机接受抗生素预防治疗(静脉输入氧氟沙星200 mg,q12h,连续2天;随后口服氧氟沙星200 mg,q12h,连续5天)或仅当证实感染后使用抗生素(按需组)。检查感染、随机分组后立即通过内镜治疗GEVB。研究人员分析了59例预防组患者和61例按需组患者。两组患者胃食管静脉曲张的临床与内镜特点、至内镜治疗的时间、随访期均不具有差异。

结果显示,抗生素预防治疗减少了感染例数(2/59例 vs 16/61例;P<0.002)。未预防性使用抗生素的患者再出血实际概率较高(P=0.0029)。再出血的差异大多为7天内的早期再出血(4/12例 vs 21/27例,P=0.0221)。7天内再出血的相对风险为5.078(95%CI:1.854-13.908,P<0.0001)。多变量Cox回归提示,细菌感染(相对风险:3.85,95%CI:1.85-13.90)和涉及肝细胞癌(相对风险:2.46,95%CI:1.30-4.63)是再出血的独立预测因素。预防组因再出血造成的输血量也减少(1.40±0.89 vs 2.81±2.29单位,P<0.05)。两组的存活率无差异。

Hou博士等总结认为,急性GEVB患者在内镜治疗后预防性使用抗生素能够防止感染和再出血、减少输血量。

Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial.
Hou MC, Lin HC, Liu TT, Kuo BI, Lee FY, Chang FY, Lee SD.

Division of Gastroenterology, Department of Medicine, Taipei-Veterans General Hospital, No. 201 Sec. 2 Shih-Pai Road, Taipei, Taiwan 11217, ROC. mchou@vghtpe.gov.tw

Bacterial infection may adversely affect the hemostasis of patients with gastroesophageal variceal bleeding (GEVB). Antibiotic prophylaxis can prevent bacterial infection in such patients, but its role in preventing rebleeding is unclear. Over a 25-month period, patients with acute GEVB but without evidence of bacterial infection were randomized to receive prophylactic antibiotics (ofloxacin 200 mg i.v. q12h for 2 days followed by oral ofloxacin 200 mg q12h for 5 days) or receive antibiotics only when infection became evident (on-demand group). Endoscopic therapy for the GEVB was performed immediately after infection work-up and randomization. Fifty-nine patients in the prophylactic group and 61 patients in the on-demand group were analyzed. Clinical and endoscopic characteristics of the gastroesophageal varices, time to endoscopic treatment, and period of follow-up were not different between the two groups. Antibiotic prophylaxis decreased infections (2/59 vs. 16/61; P <.002). The actuarial probability of rebleeding was higher in patients without prophylactic antibiotics (P =.0029). The difference of rebleeding was mostly due to early rebleeding within 7 days (4/12 vs. 21/27, P =.0221). The relative hazard of rebleeding within 7 days was 5.078 (95% CI: 1.854-13.908, P <.0001). The multivariate Cox regression indicated bacterial infection (relative hazard: 3.85, 95% CI: 1.85-13.90) and association with hepatocellular carcinoma (relative hazard: 2.46, 95% CI: 1.30-4.63) as independent factors predictive of rebleeding. Blood transfusion for rebleeding was also reduced in the prophylactic group (1.40 +/- 0.89 vs. 2.81 +/- 2.29 units, P <.05). There was no difference in survival between the two groups. In conclusion, antibiotic prophylaxis can prevent infection and rebleeding as well as decrease the amount of blood transfused for patients with acute GEVB following endoscopic treatment.

HEPATOLOGY 2004;39:746-753














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