重型病毒性肝炎预防性抗菌治疗临床对照观察  

The clinical study on prophylactic antibiotic therapy in patients with severe viral hepatitis

作　　者：苏智军[1] 郭如意[1] 柯邵鹏[1] 张奕返[1] 

机构地区：[1]福建省泉州市第一医院肝病科,362000

出　　处：《中国实用内科杂志》2004年第12期731-733,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的　观察预防性应用抗菌药物对重型病毒性肝炎医院感染的影响。方法　选择 1996 - 10～ 2 0 0 1- 12泉州市第一医院入院前 1周未经抗菌治疗、入院时无感染征象、住院时间超过 72h的重型肝炎病例 ,根据临床分期及抗菌药物应用情况进行分组、对照研究。结果　 15 9例患者中 76例发生医院感染 ,未预防性应用抗菌药物组 (A组 )、静脉注射第三代头孢菌素组 (B组 )及半合成青霉素组 (C组 )医院感染率分别为 5 6 16 % (41/ 73)、34 0 % (17/ 5 0 )和 5 0 0 % (18/ 36 )。与A组比较 ,B组早、中、晚期重型肝炎医院感染发生时间均明显推迟 ,中期、晚期重型肝炎医院感染发生率明显降低 ,中期重型肝炎病死率明显降低 ,各组差异均有显著性意义。 (P <0 0 5 )。与A组比较 ,C组各期重型肝炎的医院感染发生时间、感染发生率、病死率差异无显著意义 (P >0 0 5 )。结论　预防性应用第三代头孢菌素可推迟重型肝炎医院感染发生时间 ,降低中、晚期重型肝炎医院感染发生率 ,降低中期重型肝炎病死率。Objective To evaluate the effectiveness of prophylactic antibiotic therapy on nosocomial infection in patients with severe viral hepatitis,and inquire into its applied mechanism.Methods 159 cases of severe viral hepatitis were divided into groups according to clinical stage and the applied circumstance of antibiotic medicine;Group A:receiving no prophylactic antibiotics therapy,Group B intravenous injection of the third generation cephalosporins and Group C intravenous injection of the semisymthetic penicillins.All cases had no infection on admission and received no antibiotics for 7 days before entering hospital and had stayed in hospital over 72 hours.Results Nosocomial infection occurred in 76 patients among the 159 selected cases.The incidence of nosocomial infection of Group A,Group B and Group C was 56.16%(41/73),34.0%(17/50) and 50.0% (18/36),respectively.The occurring time of nosocomial infection of Group B in early,middle and late stage patients with severe viral hepatitis was significantly later than Group A.The incidence of nosocomial infection in middle and later stage patients was significantly lower,and the mortality was significantly decreased in middle stage patients.There was significantly difference between group A and B(P<0.05).There was no difference of occurring time,incidence and mortality of nosocomial infection between group C and A(P>0.05).Conclusion Prophylactic usage of antibiotics of third generation cephalosporins can not only delay nosocomial infection but also decrease the incidence of nosocomial infection in middle and late stage patients and mortality in middle stage patients with severe viral hepatitis.

关 键 词：重型病毒性肝炎 预防性抗菌治疗 半合成青霉素 头孢菌素 医院感染 

分 类 号：R512.6[医药卫生—内科学] R978[医药卫生—临床医学]