自发性腹膜炎的易感因素及预后相关因素的研究

Study of spontaneous peritonitis predisposing factors and prognosis related factors

目的探讨自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)的发病因素、诊治和预后相关因素。方法收集2009年5月—2012年10月新疆医科大学一附院收治的SBP病例共118例,对其易患因素、临床表现、实验室检查、细菌培养及治疗与转归进行回顾性分析,统计方法运用χ2检验。结果在118例SBP患者中有53例存在易患因素,最常见为消化道出血。有典型腹膜炎临床表现者仅5例,腹胀为最常见的症状。47例出现并发症,包括肝肾综合征、肝性脑病、电解质紊乱、消化道出血及其他部位感染。血常规中白细胞计数升高者22例,腹水细菌培养阳性9例(7.6%),其中革兰阴性菌占66.7%。使用了第3代头孢菌素及喹诺酮类抗生素及输注白蛋白治疗,治疗有效75例。肝肾功能改善及并发症减少可以改善SBP的预后。结论 SBP是失代偿期肝硬化及重症肝炎的严重并发症,临床表现不典型,临床表现难以诊断SBP,腹水穿刺检查是诊断SBP有效而客观的方法,对怀疑SBP的患者,如无腹腔穿刺禁忌证,应尽可能行腹水穿刺检查。对于确诊或者怀疑SBP者,应该早期进行治疗。SBP的预后与肝肾功能及伴有并发症有密切关系。

[ Objective] To study the risk factors, diagnosis and treatment, related factors of prognosis of spontaneous bacterial peri tonitis （SBP）. [ Methods ] The clinical data of 118 patients with SBP in the First Affiliated Hospital of Xinjiang Medical University from May 2009 - Oct 2012 were collected. The predisposing factor, clinical manifestation,laboratory examination,bacterial culture, treatment and outcome were analyzed retrospectively. The statistics method applied was x 2 test. [ Results] Fifty-three patients had predisposing factors in 118 patients,and gastrointestinal hemorrhage was the very common predisposing factor. Only 5 patients had typical manifestations of peritonitis. Abdominal distention was the most common clinical manifestation. Complication such as hepator enal syndrome, hepatic encephalopathy, electrolyte disturbance, gastrointestinal hemorrhage and infection of other parts were found in 47 patients. Twenty two patients had high leukocyte count. There were 9 positive results in ascitic bacterial culture. G-bacterium was about 66.7%. Patients were treated with the 3rd cephalosporin, quinolones and albumin. Seventy five patients were responsive to therapy. The liver function and the complications had significant effect on the final prognosis. [ Conclusion] SBP is the common and serious complication for late-stage cirrhotic patient and severe hepatitis patient. It can not be easily diagnosed only by clinical manifestation for usually lacking typical manifestation. Ascites examination is the most effective and objective method for the diagno sis of SBP. All patients suspected of SBP should receive ascites examination if without counterindication of abdominal paracentesis. The patient should be treated in time when he or she was diagnosed with SBP or suspected SBP. The liver function and the compli cations are significantly correlated with the final prognosis.