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[目的]观察预防性使用头孢吡肟对肝硬化失代偿期上消化道出血患者院内感染的预防作用,以及相关的临床意义。[方法]2014年7月~2016年7月我院收治的肝硬化失代偿期上消化道出血患者88例,使用信封法将88例患者随机分为对照组和观察组,每组44例。对照组给予基础治疗对症治疗,观察组在对照基础上预防性使用头孢吡肟1g溶于100ml 0.9%氯化钠注射液中,静滴,1次/d,连续用药7d。比较2组院内感染、再出血、死亡发生率,以及凝血酶原时间和住院天数的差异。[结果]2组患者院内感染主要以腹腔感染为主,其次为呼吸道和胃肠道感染,观察组的院内感染发生率为27.3%(12/44),显著低于对照组的52.3%(23/44)(P<0.05)。观察组再出血发生率为22.7%(10/44),显著低于对照组的40.9%(18/44)(P<0.05)。观察组死亡率为18.2%(8/44),显著低于对照组的38.6%(17/44)(P<0.05)。观察组血酶原时间为(16.14±1.37)s,显著低于对照组的(17.32±1.52)s(P<0.05)。观察组的住院时间为(15.61±2.72)d,显著短于对照组的(21.82±4.16)d(P<0.05)。2组之间感染的病原菌种类差异无统计学意义(P>0.05)。[结论]预防性使用头孢吡肟可以显著减低肝硬化失代偿期上消化道出血患者院内感染的发生率,降低患者的再出血发生率和死亡率。
[Objective] To observe the preventive effect of prophylactic use of cefepime on nosocomial infection in patients with decompensated cirrhosis and its related clinical significance. [Methods] From July 2014 to July 2016, 88 patients with decompensated cirrhosis and upper gastrointestinal hemorrhage in our hospital were treated with envelope method. 88 patients were randomly divided into control group and observation group, with 44 cases in each group . The control group was treated with symptomatic treatment of basic treatment. The observation group was treated with prophylactic cefepime 1 g dissolved in 100 ml of 0.9% sodium chloride injection on the basis of the control and intravenously for 1 d / d for 7 days. The incidences of nosocomial infections, rebleeding, and death in the two groups were compared, and the differences in prothrombin time and hospitalization days were also compared. [Results] Nosocomial infections in the two groups were mainly abdominal infections, followed by respiratory and gastrointestinal infections. The incidence of nosocomial infections in the observation group was 27.3% (12/44), significantly lower than that in the control group (52.3%, 23 /44)(P<0.05). The incidence of rebleeding in the observation group was 22.7% (10/44), significantly lower than that in the control group (40.9%, 18/44) (P <0.05). The mortality in the observation group was 18.2% (8/44), which was significantly lower than that in the control group (38.6%, 17/44) (P <0.05). The prothrombin time in the observation group was (16.14 ± 1.37) s, which was significantly lower than that in the control group (17.32 ± 1.52) s (P <0.05). The length of stay in the observation group was (15.61 ± 2.72) d, which was significantly shorter than that in the control group (21.82 ± 4.16) d (P <0.05). There were no significant differences in the types of pathogenic bacteria infected between the two groups (P> 0.05). [Conclusion] Preventive use of cefepime can significantly reduce the incidence of nosocomial infections in patients with decompensated cirrhosis of upper gastrointestinal bleeding and reduce the incidence of recurrent bleeding and mortality in patients.