关键词: 肝硬化, 上消化道出血, 美罗培南, 降钙素原, 感染, 预防

Abstract: Objective To investigate the preventive effect of meropenem on nosocomial infections in cirrhotic patients complicated by upper gastrointestinal bleeding（UGB）. Methods 86 patients liver cirrhosis （LC） complicated by UGB were recruited in our hospital between January 2015 and January 2016,and were divided into two groups by the random computer-generated numbers,with 43 cases in each group. All patients received conventional hemostatic and hepatoprotective therapy,and meropenem or ceftriaxone sodium intravenously for seven to ten days. Serum procalcitonin （PCT）,endotoxin （ETX）,tumor necrosis factor-α （TNF-α）,interleukin-6 （IL-6）, IL-8 and interferon-γ（IFN-γ） were detected. Results At the end of two weeks,the rates of infections and rebleeding in meropenem group were 9.3% and 14.0%,much lower than 25.6% and 32.6%（P<0.05） in ceftriaxone group and the 4-week mortality rates were 18.6% and 20.9%,respectively（P>0.05）;at the end of seven days,serum levels of PCT,ETX,TNF-α,IL-8 and IFN-γ in meropenem group were（0.32±0.05）ng/mL,（10.3±2.5）pg/ml,（20.5±3.6）ng/ml,（12.3±1.9）ng/ml and （19.1±3.6）ng/ml,all but IFN-γ,much lower than （0.40±0.05）ng/ml,（13.1±3.1）pg/ml,（24.2±3.9）ng/ml,（14.8±2.0）ng/ml and（16.3±3.5）ng/ml（P<0.05） in ceftriaxone group. Conclusions Meropenem could be effectively used to reduce the infection and rebleeding rates in cirrhotic patients at the urgent circumstance of UGB,which warrants further investigation.

Key words: Cirrhosis, Upper gastrointestinal bleeding, Meropenem, Procalcitonin, Infection, Prophylaxis