摘要
目的分析终末期肝病患者并自发性腹膜炎的临床特征。方法以重型肝炎、肝硬化及原发性肝癌患者为研究对象,详细记录其临床症状、体征及实验室检查,根据腹水培养及药敏试验结果选择合适的抗生素,观察其疗效及转归并判断其预后。结果终末期肝病并自发性腹膜炎(SBP)109例,占所观察532例肝病患者的20.49%,其中,重型肝炎占46.53%(47/101),肝硬化占14.61%(52/356),原发性肝癌占13.33%(10/75),分别死亡27例、4例和3例;外周血白细胞>10.0×109/L者29例(26.61%),中性粒细胞分类>0.7者62例(56.88%),体温>38℃者21例,腹水培养阳性率为19.26%,其中大肠埃希菌占培养阳性者占38.10%,治疗有效率为66.06%。结论终末期肝病并SBP临床表现不典型,存在脾功能亢进,白细胞减少,腹水培养阳性率低,因此以腹水白细胞、多形核细胞及血白细胞分类作为诊断SBP的主要依据。重型肝炎并SBP发生率高于肝硬化及肝癌,同时三者的病死率均高于不并发SBP者。因此,预防SBP的发生,给予敏感药物积极有效治疗SBP对提高终末期肝病患者疗效及改善预后有积极意义。
Objective To analyze t-he clinical features of spontaneous bacterial peritonitis （SBP） in patients with end-stage fiver disease. Method The clinical signs and symptoms, laboratory test of blood and aseites in patients with cirrhosis, severe hepatitis and primary hepatic carcinoma （PHC） were observed and analyzed. Sufficient antibiotics were given to treat these patients according to the results of culture of aseites and drug sensitive tests of bacteria and the therapeutic effects and prognosis were analyzed. Results 109 （20.49%） of 532 eases with end stage fiver disease were diagnosed as SBP. In eases with severe hepatitis, cirrhosis and PHC, the incidences of SBP were 46.53 %, 14.61%, 13.33 %, respoetively; The mortality were 57.44% ,7.69% and 30.0% ,respectively. The leukocyte count in the peripheral blood was more than 10（ 10^9/L in 29 patients;The polymorphonuclear leueocytes in differential cell count were more than 70% in 62 patients;21 patients with body temperature above 38℃0 ;Only 19.26% aseites culture were positive;Total effective rate was 66.06%. The mortality in patients with SBP is higher than that without SBP. Conclusions The symptoms and signs of SBP in patients with end-stage fiver disease are atypical. These patients often have hypersplenism; the leukocyte count decreases and the aseites culture is often negative in these patients. The leukocyte count and polymorphonulear neutrophils count in the ascites and peripheral blood should be regarded as main bases in diagnosis of SBP;The incidences of SBP in patients with severe hepatitis is higher than those with cirrhosis and PHC. The mortality of patients with SBP is higher than that without SBP. So the prevention and effective treatment of SBP are very important to improve prognosis of patients with end-stage fiver disease.
出处
《临床内科杂志》
CAS
2005年第12期834-836,共3页
Journal of Clinical Internal Medicine
关键词
肝疾病
腹膜炎
Liver disease
Bacterial peritonitis
