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目的观察头孢噻肟钠联合双歧三联活菌(培菲康)治疗肝硬化自发性细菌性腹膜炎(SBP)的临床疗效和不良反应。方法选取2013年1月至2015年8月就诊的116例肝硬化SBP患者,将患者随机分为两组。试验组58例用头孢噻肟钠联合培菲康治疗,对照组58例单用头孢噻肟钠治疗,均连续治疗10 d为1个疗程。观察比较两组患者1个疗程后的临床症状、疗效和不良反应。比较3个月时两组患者的病死率。结果治疗1个疗程后,与对照组比较,试验组治愈率显著提高(62.07%vs 41.38%,χ~2=4.971,P<0.05),临床总有效率也显著提高(96.55%vs 70.69%,χ~2=14.162,P<0.01)。试验组治疗1个疗程后血清丙氨酸氨基转移酶(ALT)和总胆红素(TBIL)水平明显下降(P均<0.01),并恢复至正常范围;对照组治疗后ALT值、TBIL水平亦明显下降(P均<0.05),但未恢复至正常范围。不良反应(头痛眩晕、胃肠道反应、上消化道出血、低血压休克、肝功能衰竭)发生率试验组均稍低于对照组,但差异均无统计学意义(P均>0.05);肝性脑病发生率试验组明显较对照组降低(20.69%vs 37.93%,χ~2=4.161,P<0.05)。治疗3个月后,试验组有3例死亡(5.17%),对照组9例死亡(15.52%),试验组患者病死率较对照组有所降低,但差异无统计学意义(χ~2=3.346,P>0.05)。结论头孢噻肟钠联合培菲康治疗肝硬化SBP能有效缓解患者的临床症状,提高临床疗效,安全性高,不良反应少。
Objective To observe the clinical efficacy and adverse reactions of cefotaxime sodium combined with bifidobacterium triple viable bacteria (Pefikang) in the treatment of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. Methods A total of 116 patients with cirrhosis SBP from January 2013 to August 2015 were selected and randomly divided into two groups. Fifty-eight patients in trial group were treated with cefotaxime sodium combined with Peifei Kang, and 58 in control group were treated with cefotaxime sodium alone for 10 days. The clinical symptoms, curative effects and adverse reactions of two groups of patients after one course of treatment were observed and compared. The mortality was compared between the two groups at 3 months. Results After 1 course of treatment, the cure rate of the experimental group was significantly higher than that of the control group (62.07% vs 41.38%, χ ~ 2 = 4.971, P <0.05), and the total clinical effective rate was also significantly increased (96.55% vs 70.69% χ ~ 2 = 14.162, P <0.01). The levels of ALT and TBIL in the experimental group decreased significantly (P <0.01) after one course of treatment, and returned to the normal range. After treatment, the levels of ALT and TBIL Also significantly decreased (P <0.05), but did not return to the normal range. The incidence of adverse reactions (headache, dizziness, gastrointestinal reactions, upper gastrointestinal bleeding, hypotensive shock, liver failure) in the experimental group was slightly lower than that in the control group, but the difference was not statistically significant (P> 0.05) The incidence of encephalopathy in the test group was significantly lower than that in the control group (20.69% vs 37.93%, χ ~ 2 = 4.161, P <0.05). Three months after the treatment, 3 cases died (5.17%) in the experimental group and 9 cases (15.52%) died in the control group. The mortality rate in the experimental group was lower than that in the control group (χ ~ 2 = 3.346, P> 0.05). Conclusion Cefotaxime combined with Peifei Kang can effectively alleviate the clinical symptoms of patients with cirrhosis and improve clinical efficacy, high safety and few adverse reactions.