静脉滴注白蛋白预防自发性腹膜炎肾功能减退的研究

Effect of Albumin Infusion on Preventing the Deterioration of Renal Function in Patients with Spontaneous Bacterial Peritonitis

目的：探讨静脉滴注白蛋白以提高血容量能否预防肾功能进一步减退，从而降低自发性腹膜炎的病死率。方法：１１２例肝硬化腹水并发自发性腹膜炎患者随机分成两组进行对照研究。Ａ组５６例，用头孢三嗪静脉滴注治疗；Ｂ组５６例，用头孢三嗪＋白蛋白静脉滴注治疗，总疗程３周。测定患者治疗前后的血清肌酐及血尿素氮变化情况以评价肾功能。结果：Ａ组患者的肾功能损害发病率为３３．９％（１９／５６），Ｂ组为８．９％（５／５６），Ｂ组患者的发病率明显低于Ａ组（Ｐ＝０．００２）。Ａ组患者的院内病死率为３０．４％（１７／５６），Ｂ组为８．９％（５／５６），Ｂ组患者的院内病死率也明显低于Ａ组（Ｐ＝０．０１）。结论：在使用抗生素的同时静脉滴注白蛋白可减少肝硬化自发性腹膜炎患者肾功能损害的发病率，从而降低其病死率。

Background/Aims: To determine whether plasma volume expansion with albumin infusion could prevent the deterioration of renal function and reduce the mortality in patients with spontaneous bacterial peritonitis. Methods: 112 cirrhotic and ascites patients with spontaneous bacterial peritonitis were randomly assigned into two groups: 56 in group A were treated with ceftriaxone, and 56 in group B were given intravenous albumin in addition for three weeks. Serum creatinine and blood urea nitrogen levels were monitored before and after the treatment for evaluation of renal function. Results: The incidence of renal deterioration was significantly lower in group B (5/56, 8.9%) than that in group A (19/56, 33.9%; P=0.002). Even more impressive was that, the mortality during hospitalization was significantly reduced from 30.4% (17/56) in group A to 8.9% (5/56) in group B (P=0.01). Conclusions: The addition of intravenous albumin to an antibiotic regimen can reduce the incidence of renal deterioration and mortality rate of cirrhotic patients with spontaneous bacterial peritonitis.