拉克替醇散联合哌拉西林钠他唑巴坦钠治疗自发性细菌性腹膜炎的临床研究

Clinical study of lactitol powder combined with piperacillin sodium and tazobactam sodium in the treatment of spontaneous bacterial peritonitis

目的探讨拉克替醇散联合哌拉西林钠他唑巴坦钠治疗自发性细菌性腹膜炎(SBP)的疗效及对机体微环境的影响。方法回顾性分析济宁医学院附属湖西医院2017年1月至2019年12月135例SBP患者的临床资料。其中,采用拉克替醇散联合哌拉西林钠他唑巴坦钠治疗68例(观察组),采用哌拉西林钠他唑巴坦钠治疗67例(对照组),比较两组疗效。记录临床症状体征恢复时间(腹痛消失时间、腹胀消失时间、腹部压痛消失时间、体温恢复时间和腹水白细胞恢复时间)、肝功能指标[丙氨酸氨基转移酶(ALT)、总胆红素、白蛋白、天冬氨酸氨基转移酶(AST)]、微循环指标[触珠蛋白、降钙素原、白细胞介素-6(IL-6)和中性粒细胞明胶酶相关脂质运载蛋白(NGAL)]、肠黏膜通透性指标(内毒素、血氨、二胺氧化酶)和不良反应(腹泻、恶心和皮肤瘙痒等)。结果观察组总有效率明显高于对照组[95.59%(65/68)比82.09%(55/67)],差异有统计学意义(P<0.05)。观察组腹痛消失时间、腹胀消失时间、腹部压痛消失时间、体温恢复时间和腹水白细胞恢复时间明显短于对照组[(6.15±1.34)d比(8.26±1.19)d、(5.34±1.29)d比(7.18±1.35)d、(7.59±1.65)d比(9.86±1.80)d、(5.28±1.20)d比(6.39±1.12)d和(10.87±2.25)d比(12.18±1.67)d],差异有统计学意义(P<0.01)。观察组治疗1和2周后ALT、总胆红素、AST、触珠蛋白、降钙素原、IL-6、NGAL、内毒素、血氨和二胺氧化酶明显低于对照组,差异有统计学意义(P<0.01);两组治疗前后组内和组间白蛋白比较差异无统计学意义(P>0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论SBP患者采用拉克替醇散联合哌拉西林钠他唑巴坦钠治疗可有效改善肝功能和肠黏膜通透性,促进机体微环境和症状恢复,效果明显。

Objective To investigate the effect of the lactitol powder combined with piperacillin sodium and tazobactam sodium in patients with spontaneous bacterial peritonitis(SBP),and the influence on the body microenvironment.Methods The clinical data of 135 patients with SBP from January 2017 to December 2019 in Huxi Hospital Affiliated Jining Medical College were retrospectively analyzed.Among them,68 patients were treated with lactitol powder combined with piperacillin sodium and tazobactam sodium(observation group),67 patients were treated with piperacillin sodium and tazobactam sodium(control group).The curative effect was compared between 2 groups.The recovery time of clinical symptoms and signs(disappearance time of abdominal pain,disappearance time of abdominal distension,disappearance time of abdominal tenderness,recovery time of body temperature and recovery time of ascites white blood cell),liver function indexes(alanine aminotransferase,ALT;total bilirubin;albumin;aspartate aminotransferase,AST),microcirculation indexes(haptoglobin;procalcitonin;interleukin-6,IL-6;neutrophil gelatinase-associated lipocalin,NGAL),intestinal mucosal permeability indexes(endotoxin,blood ammonia,diamine oxidase)and adverse reactions(diarrhea,nausea and skin itching)were recorded.Results The total effective rate in observation group was significantly higher than that in control group:95.59%(65/68)vs.82.09%(55/67),and there was statistical difference(P<0.05).The disappearance time of abdominal pain,disappearance time of abdominal distension,disappearance time of abdominal tenderness,recovery time of body temperature and recovery time of ascites white blood cell in observation group were significantly shorter than those in control group:(6.15±1.34)d vs.(8.26±1.19)d,(5.34±1.29)d vs.(7.18±1.35)d,(7.59±1.65)d vs.(9.86±1.80)d,(5.28±1.20)d vs.(6.39±1.12)d and(10.87±2.25)d vs.(12.18±1.67)d,and there were statistical differences(P<0.01).The ALT,total bilirubin,AST,haptoglobin,procalcitonin,IL-6,NGAL,endotoxin,blood ammonia and diamine oxidase 1 and 2 weeks after treatment in observation group were significantly lower than those in control group,and there were statistical differences(P<0.01);there was no statistical difference in albumin between 2 groups(P>0.05).There was no statistical difference in incidence of adverse reactions between 2 groups(P>0.05).Conclusions The lactitol powder combined with piperacillin sodium and tazobactam sodium for SBP patients can more significantly improve the liver function and intestinal mucosal permeability,and promote the body microenvironment and the recovery of symptoms.