肝功能衰竭合并自发性腹膜炎的特点分析及治疗体会

The clinical characteristics and treatment of liver failure patients with spontaneous bacterial peritonitis

目的分析肝衰竭合并自发性腹膜炎患者的临床特点及治疗疗效。方法回顾性研究201例肝硬化合并自发性腹膜炎患者,将其分为两组,分别为肝衰竭组及对照组,研究两组患者血常规、腹水细胞计数和腹水培养情况,进行t检验或χ2检验。对肝衰竭合并自发性腹膜炎患者中经验使用抗菌药物(三代头孢、莫西沙星、亚胺培南)的临床疗效进行分析。结果肝衰竭合并腹膜炎组患者血中中性粒细胞比例、PCT<2的比例、腹水细胞总数分别为(81.50±9.25)%、12.5%、(3.43±0.44)log/ml高于对照组(P<0.05)。两组腹水培养阳性率均较低,分别为22.7%及15.9%,两组间差异无统计学意义(P>0.05)。肝衰竭组腹水培养结果大肠杆菌所占比例为35.0%,对三代头孢普遍敏感率为25.0%,均低于对照组(分别为72.2%,66.7%),差异有统计学意义(P<0.05)。在肝衰竭合并腹膜炎组中应用亚安培南及莫西沙星治疗的有效率分别为84.0%、74.0%,高于三代头孢(52.6%),平均治疗时间分别为(7.10±1.64)d、(8.50±2.57)d短于三代头孢组(12.20±4.11)d,差异有统计学意义(P<0.05)。结论肝衰竭合并自发性腹膜炎的感染重,腹水培养阳性率低,对三代头孢的敏感率低,亚安培南及莫西沙星治疗疗效优于三代头孢。

Objective To investigate the clinical characteristics and treatment of liver failure patients with spontaneous bacterial peritonitis（SBP）.Methods A total of 201 liver cirrhosis patients with SBP were retrospectively divided into liver failure group and control group.The complete blood count,ascites cell count and ascites culture were compared between the two groups.The curative effect of antibiotic therapy on liver failure patients with SBP was observed.Results The ratio of neutrophil,ratio of PCT 2,and ascites cell count in liver failure group were higher than the non liver failure group（P 0.05）.The positivity rates of ascites culture in both groups were lower.The positivity rate of Escherichia coli and the sensitivity to Moxifloxacin in liver failure group was lower than the control group（35.0% vs 72.2%,25.0% vs 66.7%,P 0.05）.The clinical effect of treatment with Imipenem trial and Moxifloxacin group were significantly higher than the Cephalosporin group（P 0.05）.The treatment duration with Imipenem or Moxifloxacin was significantly shorter than that of Cephalosporin（P 0.05）.Conclusion The disease severity is higher but the ascites culture positivity rate is lower in liver failure patients compared to the control group.The sensitivity to Moxifloxacin in liver failure group was lower.The curative effect of Imipenem and Moxifloxacin is better than Cephalosporins.