摘要
目的:探讨肝硬化并发自发性细菌性腹膜炎(SBP)的发病因素及预后相关因素。方法:收集复旦大学附属中山医院1996年11月-2003年8月间收治的89例肝硬化SBP患者并临床对资料作回顾性分析。结果:89例患者中既往有SBP史5例,腹泻和消化道出血为SBP常见诱因;临床表现较典型者51例(57.3%),38例(42.7%)出现并发症;ChildB级+C级73例(81.9%),平均腹水蛋白浓度5.98g/L;腹水培养阳性17例,共培养出细菌19株,其中G杆菌占57.9%.G+球菌占36.8%;头孢噻肟、头孢他啶、头孢曲松、环丙沙星等为临床常用的抗生素;89例中,治疗有效者69例,死亡33例;本组研究表明,肝肾功能不佳和有并发症会显著影响患者的生存率。结论:SBP是肝硬化的严重并发症,临床表现变化不一;诊断的关键在于腹水检查,腹水培养血瓶法应列为常规;经验治疗首选第三代头孢菌素,同时注意保护肝肾功能,对存在易患因素的肝硬化患者应予预防性治疗。
Objective: To investigate the risk factors, the diagnosis and treatment, the prognosis-related factors of Spontaneous Bacterial Peritonitis( SBP) in cirrhotic patients. Methods: The clinical data of 89 patients with liver cirrhosis complicated by SBP from 1996 to 2003 were analysed. Results; Diarrhea or gastrointestinal hemorrhage were common predisposing factors; Typical manifestations were seen in 51 (57. 3%) cases and 38(42. 7%) cases developed complications; The patients distributed into Child Pugh B and C were 73 (81. 9% ) totally; The mean concentration of asciles protein was 5. 98g/L; Positive ascites culture were found in 17 cases and 19 organisms were isolated. Gram-negative bacilli accounted for 57. 9% and Gram-positive cocci for 36. 8%. The frequently administered antibiotics included cefo-taxime, ceftazidime. ceftriaxone, ciprofloxacin, etc. 69(77.5%) patients were responsive to therapy. The mortality rate was 37. 1 % and correlated with liver function, renal function and complications closely. Conclusion:SBP is a serious complication of cirrhosis. Its clinical features are variable and a diagnostic paracentesis is essential for confirmation. The inoculation of ascites into blood culture bottles should be applied routinely. The third-generation cephalosporin was the first option in the empiric antibiotic treatment. Meanwhile, the protection of liver function or renal function should be emphasized. Prophylactic antibiotics is suggested to be gis'en patients with risk factors of SBP.
出处
《中国临床医学》
北大核心
2005年第3期430-432,共3页
Chinese Journal of Clinical Medicine
关键词
肝硬化
自发性细菌性腹膜炎
抗生素
Cirrhosis
Spontaneous
Bacterial
Peritonitis: Antibiotics