腹腔置管在肝硬化并发自发性腹膜炎中的临床应用观察

Clinical Observation of Peritoneal Catheterization in Patients with Liver Cirrhosis complicated with Spontaneous Peritonitis

目的通过对自发性腹膜炎患者使用中心静脉置管与普通腹穿比较,明确中心静脉置管在自发性腹膜炎患者的临床应用价值及并发症处理。方法将65例明确自发性腹膜炎患者随机分2组,分别进行中心静脉腹腔置管和普通腹穿多次引流,2组患者其他治疗相同。治疗结束后对患者腹水白细胞数,PMN及其他肝功情况,并发症进行临床比较。结果 2组间患者治疗前后患者腹水白细胞数,腹水多形核白细胞(PMN),治疗时间,肝功各项指标均较治疗前好转。组间比较,置管组治疗后腹水细胞数,PMN,治疗时间改变明显优于常规组,但其他肝功指标组间变化无统计学意义。置管组较常规组局部穿刺部位感染,置管脱落,腹水渗漏,置管阻塞多于常规组,而常规组出现血压下降,头晕等全身不适症状并发症多于置管组。结论使用中心静脉置管组患者临床疗效优于普通治疗腹穿患者,但各种并发症多于普通治疗组。根据患者实际情况进行中心静脉腹腔置管灌注,抗生素注入能够提高临床疗效,避免并发症。

Objective To compare the clinical value and complication of central venous catheterization in patients with spontaneous peritonitis by comparing the use of central venous catheters and general abdominal worn in patients with spontaneous peritonitis. Methods The 65 cases of spontaneous peritonitis were randomly divided into two groups, respectively, the central venous catheter and general abdominal drainage multiple drainage. The 2 groups of patients were the same the other treatment. After treatment, the patient ascites WBC, PMN and other liver conditions were compared clinical complications. Results The number of patients with ascites leukocytes, ascites polymorphonuclear leukocytes（PMN）, treatment time, and liver function were improved before and after treatment in both groups. Between groups, the number of ascites cells, PMN, and treatment time in the catheterization group were significantly better than those in the conventional group, but there was no significant difference in other liver function indicators. In the catheterization group, local puncture site infection was more common than in the conventional group. The tube was detached, the ascites leaked, and the tube was more obstructed than in the conventional group. However, in the conventional group, blood pressure decreased, dizziness, and other symptoms of systemic discomfort were more common than in the catheterization group. Conclusion The use of central venous catheter in patients with clinical efficacy is superior to the general treatment of abdominal worn patients, but a variety of complications than the general treatment group. According to the actual situation of patients with central venous catheter perfusion, antibiotic injection can improve clinical efficacy and avoid complications.