肝硬化黄疸患者胆道细菌病原学分析对合理应用抗生素治疗的影响  

Influence of Pathogenic Analysis of Biliary Tract Bacteria on Rational Antibiotic Therapy in Cirrhotic Patients with Jaundice

作　　者：黄旭明 王博智 翁少涛 HUANG Xu-Ming;WANG Bo-Zhi;WENG Shao-Tao(Hepatology Center,The Second People's Hospital of Shantou,Shantou 515031,China)

机构地区：[1]汕头市第二人民医院肝病中心,广东汕头515031

出　　处：《中国药物经济学》2023年第9期75-79,共5页China Journal of Pharmaceutical Economics

基　　金：汕头市科技计划医疗卫生类别项目(190327225269186)。

摘　　要：目的探讨肝硬化黄疸患者胆道细菌病原学分析对合理应用抗生素治疗的影响。方法选取2018年6月至2021年2月汕头市第二人民医院收治的肝硬化黄疸患者178例作为研究对象,随机分为A组(n=53)、B组(n=57)和C组(n=68)。A组采用常规护肝治疗,并予以口服丁二磺酸腺苷蛋氨酸肠溶片;B组在A组治疗方案基础上给予经验性抗感染治疗;C组在A组治疗方案基础上,根据胆汁病原菌药敏试验结果给予针对性抗感染治疗。分析病原菌构成及药敏试验结果,并比较3组患者治疗前后终末期肝病模型(MELD)评分、Child-Pugh分级评分、肝功能指标和凝血功能指标。结果在C组68例患者中一共检出60株病原菌,其中革兰阴性菌38株(63.3%)、革兰阳性菌21株(35.0%)、真菌1株(1.7%)。革兰阴性菌对氨苄西林、头孢唑林、头孢曲松、氨曲南、头孢呋辛、环丙沙星、左氧氟沙星、阿莫西林等药物耐药率高,革兰阳性菌对利福平、克林霉素、青霉素、环丙沙星、红霉素、四环素、左氧氟沙星等抗菌药物的耐药率较高。治疗后,C组MELD评分、Child-Pugh分级评分低于A组、B组,差异有统计学意义(P<0.05);C组总胆红素(TBIL)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)低于A组、B组,凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)短于A组、B组,纤维蛋白原(FBG)高于A组、B组,差异有统计学意义(P<0.05)。结论肝硬化黄疸患者胆汁感染以大肠埃希菌、肺炎克雷伯菌、粪肠球菌为主,对常用抗生素的耐药性较高。临床根据药敏试验结果合理应用抗生素治疗可有效改善患者肝功能和凝血功能,缓解病情。Objective To explore the influence of pathogenic analysis of biliary tract bacteria on the rational use of antibiotics in patients with cirrhosis of jaundice.Methods A total of 178 patients with cirrhosis jaundice admitted to the Second People's Hospital of Shantou from June 2018 to February 2021 were selected as the study subjects and randomly divided into group A(n=53),group B(n=57)and group C(n=68).Group A was treated with routine liver protection and was given oral enteric-coated tablets of adenosylmethionine butadisulfonate.Group B was given empirical anti-infective therapy on the basis of group A;Based on the treatment plan of group A,group C was given targeted anti-infective treatment according to the results of bile pathogen drug sensitivity test.The composition of pathogenic bacteria and the results of drug susceptibility test were analyzed,and the model of end-stage liver disease(MELD)score,Child-Pugh grade score,liver function index and coagulation function index were compared between the three groups before and after treatment.Results A total of 60 strains of pathogenic bacteria were detected in 68 patients in group C,including 38 Gram-negative bacteria(63.3%),21 Gram-positive bacteria(35.0%)and 1 fungus(1.7%).The resistance rate of gram-negative bacteria to ampicillin,cefzolin,ceftriaxone,amtriaxam,cefuroxime,ciprofloxacin,levofloxacin and other drugs was high,while the resistance rate of gram-positive bacteria to rifampicin,clindamycin,penicillin,ciprofloxacin,erythromycin,tetracycline,levofloxacin and other antibacterial drugs was high.After treatment,MELD score and Child-Pugh grading score of group C were lower than those of group A and group B,and the difference was statistically significant(P<0.05).Total bilirubin(TBIL),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in group C were lower than those in groups A and B,prothrombin time(PT)and activated partial prothrombin time(APTT)were shorter than those in groups A and B,and fibrinogen(FBG)was higher than those in groups A and B,

关 键 词：肝硬化黄疸 细菌病原学 胆汁感染 药敏试验 

分 类 号：R575.2[医药卫生—消化系统] R978.1[医药卫生—内科学]