重症肝炎患者自发性细菌性腹膜炎临床观察

Clinical symptoms of severe hepatitis patients complicated with spontaneous bacterial peritonitis

目的探讨重症肝炎并发自发性细菌性腹膜炎(SPB)的临床症状及病原菌分布,以减少SBP的感染率,提升康复成功率。方法对52例重症肝炎并发自发性细菌性腹膜炎患者的临床特点进行回顾性分析。结果 52例患者腹水常规检查:31例腹水中白细胞≥0.5×109/L,46例腹水中多形核白细胞(PMN)≥0.25×109/L,感染性腹泻13例、腹水细菌培养呈阳性34例;SBP的主要诱因有感染性腹泻、上呼吸道感染、泌尿系统感染、压疮等,尚有部分病例的诱因无法查明,其中上呼吸道感染占60.0%,其次为泌尿系统感染,占28.8%;34例患者腹水细菌培养呈阳性,阳性率为65.4%,共分离出病原菌23株,其中大肠埃希菌所占比例最高,为47.8%,其次为产气肠杆菌和肺炎克雷伯菌,分别占17.4%和13.0%;好转治愈17例,占32.7%,恶化或无效35例占67.3%。结论积极防治肠道感染、上呼吸道感染,早期进行病情观察、合理饮食、保证休息和适当身心护理是SPB患者康复的关键。

OBJECTIVE To investigate the clinical symptoms of the severe hepatitis patients complicated with spontaneous bacterial peritonitis and analyze the distribution of pathogens so as to reduce the incidence of spontaneous bacterial peritonitis and improve the success rate of rehabilitation.METHODS The clinical characteristics of 52severe hepatitis patients complicated with spontaneous bacterial peritonitis were retrospectively analyzed.RESULTS The routine examination of the ascites of the 52patients showed that there were 31cases with the total leukocytes counts no less than 0.5×109/L,46cases with polymorphonuclear leukocytes counts in the ascites no less than 0. 25×109/L,13cases of infective diarrhea,and 34cases with positive bacterial culture of ascites.The major predisposing factors for the spontaneous bacterial peritonitis included the infective diarrhea,upper respiratory tract infection,urinary tract infection,and pressure sores;while the predisposing factors for some cases remained unclear.The patients with upper respiratory tract infections accounted for 60.0%,the patients with urinary tract infections 28.8%.The ascites were cultured positive in 34cases with the positive rate of 65.4%.A total of 23 strains of pathogens have been isolated,among which the Escherichia coli ranked the first place（47.8%）,followed by the Escherichia（17.4%）and Klebsiella pneumoniae（13.0%）.Totally 17cases were improved or cured,accounting for 32.7%,and 35cases were exacerbated or ineffective,accounting for 67.3%.CONCLUSION It is the key for the rehabilitation of the patients with spontaneous bacterial peritonitis to actively prevent the intestinal infections and upper respiratory tract infections,conduct early observation of illness condition and balanced diet,ensure adequate rest,and take appropriate physical and psychological nursing measures.