肝硬化合并原发性腹膜炎111例诊断与治疗

Diagnosis and treatment of 111 patients with cirrhosis complicated by spontaneous bacterial peritonitis

目的提高治疗肝硬化合并原发性腹膜炎患者的疗效和改善预后。方法以肝硬化合并原发性腹膜炎患者为研究对象,详细记录患者的体温、腹部症状、体征、血象、腹水中多核细胞数和腹水培养情况。在输注血浆、白蛋白等对症治疗的基础上,根据药敏试验和临床经验使用适当的抗菌药物,观察患者的体温、腹部症状和体征的转归情况。结果近7年半收治各类肝硬化患者299例,确诊或疑诊为原发性腹膜炎患者共111例,伴有不同程度的腹胀、腹痛、腹部压痛、反跳痛和张力增高等症状和体征,感染发生率37.12%(111/299)。体温高于37.4℃75例;外周血WBC计数>10×109/L35例;中性粒细胞分类>80%34例;腹水中多核细胞计数>0.25×109/L33例。腹水培养结果仅1例患者细菌培养阳性。肝硬化合并原发性腹膜炎患者Child-pughB和C级人数明显多于Child-pughA级者。治愈、好转61例(55.0%),无效、恶化26例(23.4%),死亡24例(21.6%)。结论肝硬化患者合并原发性腹膜炎的症状和体征不够典型,腹水培养阳性率低。及时有效的使用合适的抗菌药物治疗,能提高疗效、改善预后。

Objective To improve the diagnosis and treatment of patients with cirrhosis complicated by spontaneous bacterial peritonitis（SBP） and get better curative effect and prognosis. Methods The body temperaturs, symptoms and signs in the abdomen were recorded, blood routine test performed, the polymorphonuclear （PMN） cell counts determined and ascites culture conducted in the 111 patients with cirrhosis. These patients were given supportive therapies including using plasma and albumin as well as antibiotics treatment according to drug sensitivity and physician＇s clinical experience. The changes of the body temperatures, symptoms and signs were determined to evaluate the therapeutic effect. Results During the past 7.5 years, 299 patients was diagnosed to suffer from cirrhosis and the SBP infection rate was 37.12% （ 111/299 ）. The 111 patients of cirrhosis with SBP were diagnosed by ascites culture or clinical experience with various degrees of symptoms and signs such as distention, pain, touch pain and higher tension in the abdomen. Among them, 75 patients had abnormal body temperaturs over 37.4℃, 35 had the leukocyte counts in the peripheral blood over 10 × 109/L, 34 had PMN over 80% in differential cell counts and 33 had PMN more than 0.25 x 109/L in ascites. Only one patient was positive for the culture. The number of the patients with Child-pugh B and C was significantly higher than that of Child-pugh A. Sixty-one patients were cured, 26 had no improvements or presented deterioration and 24 died. Conclusions The signs and symptoms of patients with cirrhosis complicated by SBP are atypical. Ascites culture-positive rate is not high. Early diagnosis and proper use of antibiotics according to culture is important to enhance therapeutic effect and improve prognosis.