急性胃食道靜脈瘤出血使用抗生素、輸血之比較

Use of prophylactic antibiotics, blood transfusion during acute esophageal variceal bleeding

林惠珍(Hui-Chen Lin)

指導教授 ： 羅錦河

義守大學/醫學院/醫務管理學系/碩士(2014年)

https://doi.org/10.6343/ISU.2014.00017

摘要

本研究想探討某區域教學醫院對於急性食道靜脈瘤出血之患者接受標準作業流程之比率有多少，治療後的再出血率、感染率及存活率之情形，與標準作業流程之患者有無差別。
採回溯性研究，搜尋南部某區域醫院2005年1月1日至2006年12月30日及2012年之胃食道靜脈瘤出血之病患進行病歷分析。
總共納入胃食道靜脈瘤出血之病患203人，2005~2006年90人；2012年113人進行統計分析，有併用血管收縮劑者分別為90%及95%，(p=0.22)沒有顯著差異；有使用預防性抗生素者6.8%及83%，(p<0.05)有顯著差異；2005-2006年血色素>7g/dl之病患總共77人，有輸血病患52人；2012年血色素>7g/dl之病患總共81人，有輸血病患69人 (67% vs 85%,p<0.05)，兩者之間有顯著差異
結論：(1)併用血管收縮劑之比率，在前後兩個世代並無差別，都在90%以上。(2)使用預防性抗生素之觀念，在後面這個世代有大幅提升。(3)血色素7g/dl以下輸血之比率，在前後兩個世代有顯著差異；可見近年多數醫生看到急性食道靜脈瘤出血時，有大量輸血之習慣；幸虧這樣的輸血策略對我們之病患還看不出不良之影響。(4)由以上因素之分析，可見在急性食道靜脈瘤出血時，除了緊急內視鏡治療之外，併用血管收縮劑及使用預防性抗生素之概念已深植醫生之心裏並付諸實行，但輸血之觀念還有待改進。

關鍵字

食道靜脈瘤出血 ； 輸血 ； 預防性抗生素

並列摘要

This study deals with a teaching hospital for patients with acute esophageal variceal bleeding acceptance of the number of standard treatment procedures, rebleeding rate after treatment, infection and survival of the situation, compared with the patients who did not receive the standard treatment procedures.
This study was conducted to investigate patients with acute esophageal variceal (EV) bleeding, who were admitted to the hospital between January 2005 to December 2006, 90 patients; and January to December 2012, 113 patients; were retrospectively analyzed.
Regarding the use of vasoconstrictors, 90% 2005-2006 cohort and 95% in the 2012 cohort had this combination (p=0.22). Use of prophylactic antibiotics was 6.8% in the 2005-2006 cohort and 83% in the 2012 cohort (p<0.05). The frequency of blood transfusion in hemoglobin>7g/dl was 67% and 85%, respectively. Rebleeding rates were similar between the 2 cohorts, irrespective of vasoconstrictor, prophylactic antibiotic or blood transfusion.
Conclusion:：(1)The frequency of using vasoconstrictor was no significant different in the two cohort, in more than 90%.(2)Use of prophylactic antibiotics in 2012 cohort has increased significantly.(3)The frequency of blood transfusions in hemoglobin <7g/dl was still very high in the two cohort.(4)By the analysis of the above factors seen in acute variceal bleeding aside from endoscopic therapy, the concept of using prophylactic antibiotics and vasoconstrictor agents have been deeply rooted in the hearts and implemented by clinicians, but transfusions policy has a room to be improved.

並列關鍵字

esophageal variceal bleeding ； blood transfusions ； prophylactic antibiotics

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