在广泛的抗生素治疗期间,可以停止治疗肝脏脑病的利法西明吗?
Chien-Hao Huang1, Piero Amodio2
1Division of Hepatology, Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan.
World journal of hepatology
|March 18, 2024
概括
在重症患者的肝脑病变 (HE) 广泛抗生素治疗期间停止使用利法西明 (RFX) 可能是安全的. 这种方法没有增加神经系统不良事件或死亡率,这表明了优化的治疗策略.
科学领域:
- 肝病学和胃肠病学 肝病学和胃肠学
- 传染病和药理学 传染病和药理学
背景情况:
- 肝脑病变 (HE) 是不补偿性肝硬化症的严重并发症.
- 利法西明 (RFX) 是HE预防的标准治疗方法,可减少感染和死亡率.
- 关于在HE患者中同时使用RFX与宽谱抗生素的数据有限.
研究的目的:
- 评估在接受广谱抗生素的HE患者中持续RFX的必要性和安全性.
- 探索在重症病房ICU患者中没有不良影响的RFX停止的潜力.
主要方法:
- 进行了一项由药剂师驱动的准实验试点研究.
- 研究了在接受广谱抗生素的ICU重症肝硬化患者中停止RFX治疗.
- 评估的神经结果 (妄,昏迷) 和二次临床结果 (死亡率,血管压缩剂使用).
主要成果:
- 即使在多变量调整后,停用RFX也没有与 Delirium 或昏迷率的增加有关.
- 二次结果,包括ICU死亡率和血管压缩剂需求,在各组之间是可比的.
- 表明RFX在HE中的有效性可能是特定于类 (肠道微生物群调节),而不是特定于药物.
结论:
- 在已经接受广谱抗生素的重症患者中,RFX可能不需要用于HE管理.
- 停止治疗似乎是安全的,需要进一步研究以优化治疗策略.
- 需要进一步的前性多中心试验与安慰剂对照来证实这些发现.
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