结肠灌注透析机配合弱酸灌洗液在慢性重症肝炎中的应用

目的观察结肠灌注透析机配合弱酸灌洗液在慢性重症肝炎治疗中的效果。方法将84例重症肝炎患者随机分为观察组和对照组,各42例,对照组采用常规综合治疗,观察组在常规综合治疗的基础上配合结肠灌注透析机和弱酸灌洗液进行灌肠治疗。比较2组患者治疗后的血清肝功能指标、血氨值、凝血功能、临床症状的改善以及治疗效果。结果治疗20d后,观察组患者血清肝功能指标、血氨值、凝血功能等指标下降幅度均大于对照组（p均〈0．05）,且治疗效果优于对照组（p〈0．01）。结论结肠灌注透析机配合弱酸灌洗液灌肠治疗慢性重症肝炎安全,且能明显提高临床疗效。     

重症肝炎并自发性腹膜炎80例临床分析

自发性细菌性腹膜炎 (ｓｐｏｎｔａｎｅｏｕｓｂａｃｔｅｒｉａｌｐｅｒｉｔｏｎｉｔｉｓ,ＳＢＰ)又称特发性细菌性腹膜炎 ,是重型病毒性肝炎常见并发症之一 ,因其临床表现常不典型和多样化 ,故极易漏诊。 1 994年 1月～ 2 0 0 1年 1 2月 ,我院收治重型病毒性肝炎并发ＳＢＰ 80例 ,本文对其临床特点、细菌学发现、抗菌治疗及临床转归等进行回顾分析。结果报告如下。1　资料与方法1 .1　一般资料　本组 80例均为临床确诊的重型肝炎住院患者 ,男 69例 ,女 1 1例 ;平均年龄 38.2岁。诊断分型按 2 0 0 0年9月 (西安 )全国病毒性肝炎学术会议修订…     

重症肝炎并自发性腹膜炎80例临床分析

自发性细菌性腹膜炎 (ＳＢＰ)是重型病毒性肝炎常见并发症之一 ,因其表现常不典型和多样化 ,临床极易漏诊 ,我们对我院 1994年 1月～ 2 0 0 1年 12月收治的重型病毒性肝炎并发ＳＢＰ的发生情况 ,临床特点、细菌学发现、抗菌治疗及临床转归等相关问题进行了观察分析。1　资料和方法1 1　病例选择 :80例病例均为住院患者 ,均经临床确诊的重型肝炎病例 ,诊断分型按 2 0 0 0年 9月 (西安 )全国病毒性肝炎学术会议修订的标准 ,其中急性重症肝炎 4例 ,亚急性重症肝炎 16例 ,慢性重症肝炎 6 0例 ,男 6 9例 ,女 11例 ,平均年龄 38 2岁。1 2　ＳＢＰ…     

重症肝炎并发自发性细菌性腹膜炎的临床观察及护理

目的探讨重症肝炎并发自发性细菌性腹膜炎(SBP)的观察方法及护理对策。方法对120例重症肝炎并发SBP患者临床特点及护理措施进行回顾性分析。结果临床表现为发热102例(85.0%),腹痛52例(43.3%),腹部压痛62例(51.6%)。SBP诱因依次为感染性腹泻23例(19.2%),上呼吸道感染19例(15.8%),泌尿系感染5例(4.2%),压疮2例(1.7%),原因不明71例(59.2%)。治愈好转30例(25.0%),恶化或无效90例(75.0%)。结论重症肝炎并发SBP临床表现不典型,病死率高。加强病情观察、积极预防肠道及上呼吸道感染、注重心理护理是提高生存率的重要护理措施。     

中药灌肠治疗慢性重症肝炎患者的护理体会

慢性重症肝炎病情凶险,并发症多,病死率高。目前仍无特效治疗方法。2004年7月～2005年7月我科对55例慢性重症肝炎患者在常规、支持治疗的同时加用中药保留灌肠,取得了较好的疗效,现将护理体会报告如下。     

结肠透析配合中药保留灌肠在慢性肾衰竭病人护理中的应用

[目的]探讨结肠透析联合中药保留灌肠治疗早中期慢性肾衰竭病人的疗效。[方法]将慢性肾衰竭病人78例分为两组,治疗组48例,对照组30例。治疗组采用结肠途径治疗机联合中药保留灌肠治疗,对照组采用同样中药液,常规保留灌肠。[结果]两组病人治疗后恶心、呕吐、胃纳差、乏力等症状明显减轻或消失,治疗组明显优于对照组;两组病人治疗后血肌酐(Scr)、尿素氮(BUN)较治疗前降低,但治疗组比对照组改善明显。[结论]结肠透析联合中药保留灌肠治疗早中期慢性肾衰竭,治疗效果优于传统灌肠法。     

32例重型肝炎合并自发性细菌性腹膜炎的治疗体会

选取我院2012年10月~2013年10月收治的68例重型肝炎的患者为研究对象,将单纯患有重型肝炎的36患者作为观察组,将重型肝炎伴有自发性细菌性腹膜炎的32例患者作为参照组,对比两组患者的诊疗效果。结果观察组患者治疗效果明显高于对照组患者,观察组患者的治疗的总有效率为86.11%,对照组患者治疗的总有效率为66.13%,两组比较情况具有统计学意义,即P0.05。观察组中的白细胞数与参照组患者比较具有统计学差异,即P0.05。而观察组中的中性粒细胞比值明显高于参照组患者,两组比较差异具有统计学意义,P0.05。针对重型肝炎伴有自发性细菌性腹膜炎的临床表现缺少特异性,有较多的致病菌,经过腹水检查的效果不显著,其中中性粒细胞的检测为患者早期的诊治工作提供了重要依据。     

重症肝炎并发自发性细菌性腹膜炎病人的临床观察及护理

自发性细菌性腹膜炎（spontaneous bacterial peritonitis,SBP）是重症肝炎常见和严重的并发症,可迅速进展为感染性休克和肝肾功能衰竭,危及病人生命。对SBP实施及时诊治和有效的护理,是提高重症肝炎病人生存率的重要措施。现将120例并发SBP重症肝炎病人临床特点及其护理总结如下。     

结肠途径治疗机行回流灌肠的护理体会

目的:探讨结肠途径治疗机行回流灌肠的正确护理措施。方法:通过对62例患儿175次经结肠途径治疗机行回流灌肠的护理观察,总结临床护理体会。结果:加强健康宣教、心理护理,及时解决灌肠时遇到的问题,密切观察灌肠过程中及灌肠后患儿的表现,可有效预防并发症的发生。结论:正确的护理措施可保证治疗的安全性和有效性,对减轻患儿痛苦、缩短住院时间和降低并发症起着至关重要的作用。     

结肠途径治疗机治疗急性肠炎的观察与护理45例

目的 观察结肠途径治疗机治疗急性肠炎的方法、护理措施及效果。方法2000-2003年运用结肠途径治疗机进行结肠清洗，再注入药物保留灌肠治疗急性肠炎。结果 经结肠途径治疗后，治愈时间明显缩短，腹泻及呕吐症状明显消失，体温降至正常。结论 护士熟练运用结肠途径治疗机进行结肠清洗再配合药物保留灌肠，能使肠炎临床症状得到迅速改善，效果显著。     

乙型肝炎肝硬化腹水并发自发性细菌性腹膜炎的危险因素分析

目的 探讨乙型肝炎肝硬化腹水患者并发自发性细菌性腹膜炎（SBP）的危险因素.方法 将218例乙型肝炎肝硬化腹水患者按有无SBP分为SBP组（128例）和非SBP组（90例）.对2组年龄、性别、血清白蛋白（ALB）、总胆红素（TBIL）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、凝血酶原活动度（PTA）、Child-Pugh分级、腹水总蛋白和是否合并糖尿病、上消化道出血等因素进行单因素及多因素Logistic回归分析.结果 单因素分析示：SBP组血清TBIL高于非SBP组,血清ALB、PTA及腹水总蛋白低于非SBP组（均P＜0.05）;SBP组Child-Pugh C级、合并糖尿病及上消化道出血的比例分别为77.34％、12.50％及9.38％,非SBP组Child-Pugh C级、合并糖尿病及上消化道出血的比例分别为48.89％、3.33％及2.22％,SBP组均明显高于非SBP组（均P＜0.05）.多因素Logistic回归分析示：血清TBIL、Child-Pugh分级及腹水总蛋白进入回归模型,这3项指标是乙型肝炎肝硬化腹水患者发生SBP的独立危险因素（P＜0.01）.结论 乙型肝炎肝硬化腹水患者并发SBP的危险因素众多,其中血清TBIL、Child-Push分级、腹水总蛋白是发生SBP的独立危险因素.     

肝炎后肝硬化自发性细菌性腹膜炎临床分析

目的探讨肝炎后肝硬化自发性细菌性腹膜炎（spontaneous bacterial peritonitis,SBP）的诊疗情况及头孢哌酮舒巴坦联合左旋氧氟沙星对SBP的治疗效果。方法对2004年1月2009年12月收治的54例肝炎后肝硬化SBP患者,应用头孢哌酮舒巴坦联合左旋氧氟沙星给与治疗,并观察分析治疗效果。结果肝炎后肝硬化SBP的临床表现以发热,腹痛为主,具有典型腹膜刺激征的不足半数。外周血白细胞升高者不多见,腹腔积液中白细胞计数、PMN计数和细菌培养是自发性细菌性腹膜炎的重要诊断指标。结论肝炎后肝硬化合并SBP的临床表现不典型。致病菌以G-杆菌为主。在早期诊断、综合治疗的基础上,头孢哌酮舒巴坦联合左旋氧氟沙星对自发性细菌性腹膜炎的治疗效果显著。     

Clinical Impression and Ascites Appearance Do Not Rule Out Bacterial Peritonitis

Background

Previous research has demonstrated that physician clinical suspicion, determined without assessing fluid appearance, is not adequate to rule out spontaneous bacterial peritonitis (SBP) without fluid testing.

Study Objective

To determine the sensitivity of physician clinical suspicion, including a bedside assessment of fluid appearance, in the detection of SBP in Emergency Department (ED) patients undergoing paracentesis.

Methods

We conducted a prospective, observational study of ED patients with ascites undergoing paracentesis at three academic facilities. The enrolling physician recorded the clinical suspicion of SBP (“none,” “low,” “moderate,” or “high”), and ascites appearance (“clear,” “hazy,” “cloudy,” or “bloody”). SBP was defined as an absolute neutrophil count ≥250 cells/mm³, or culture pathogen growth. We defined “clear” ascites fluid as negative for SBP, and “hazy,” “cloudy,” or “bloody” as positive. A physician clinical suspicion of “none” or “low” was considered negative for SBP, and an assessment of “moderate” or “high” was considered positive. The primary outcome measure was sensitivity of physician clinical impression and ascites appearance for SBP.

Results

There were 348 cases enrolled, with SBP diagnosed in 43 (12%). Physician clinical suspicion had a sensitivity of 42% (95% confidence interval [CI] 29–55%) for the detection of SBP. Fluid appearance had a sensitivity of 72% (95% CI 58–83%).

Conclusion

Physician clinical impression, which included an assessment of fluid appearance, had poor sensitivity for the detection of SBP and cannot be used to exclude the diagnosis. Routine laboratory fluid analysis is indicated after ED paracentesis, even in patients considered to have a low degree of suspicion for SBP.     

肝硬化并发自发性细菌性腹膜炎发病危险因素分析

目的探讨肝硬化并发自发性细菌性腹膜炎(SBP)的发病危险因素。方法连续收集2008年1月~2010年12月在惠州市中心人民医院及惠州市第一人民医院住院确诊为肝硬化合并SBP的206例病例资料。对可能影响肝硬化患者发生SBP的危险因素进行单因素分析,将有意义的因素纳入Logistic回归模型进行多因素分析。结果 MELD评分,脾脏厚度和腹水总蛋白最终进入了Logistic回归方程,OR分别为4.703、3.864、7.108。结论 MELD评分、脾脏厚度、腹水总蛋白可能为SBP发生的独立危险因素。     

头孢哌酮钠舒巴坦钠治疗肝硬化并发自发性细菌性腹膜炎的临床研究

目的研究头孢哌酮钠舒巴坦钠治疗肝炎后肝硬化并发自发性细菌性腹膜炎(SBP)的临床效果。方法选取我院2011年1月~2013年12月肝炎后肝硬化并发SBP患者68例,随机分为观察组和对照组各34例。观察组给予头孢哌酮钠舒巴坦钠治疗,对照组给予左氧氟沙星治疗,比较两组患者的临床疗效。结果观察组总有效率明显高于对照组,两组比较差异具有统计学意义(P0.05)。结论头孢哌酮钠舒巴坦钠治疗肝炎后肝硬化并发SBP疗效显著,值得临床推广应用。     

肝硬化并发自发性细菌性腹膜炎的临床分析

目的探讨肝硬化并发自发性细菌性腹膜炎（SBP）病原菌种类、临床特点，提出针对性的预防护理措施，提高抢救成功率，降低死亡率。方法对53例肝硬化并发SBP患者的临床资料进行回顾性分析。结果53例肝硬化惑者中33例腹水细菌培养阳性，阳性率62．3％；共分离细菌33株，包括11种细菌，病原菌以革兰氏阴性杆菌为主，其中大肠杆菌16株，为主要致病菌，占48．5％；药物敏感试验对第三代头孢菌素和第三代氟喹诺酮类药物敏感。结论肝硬化并发SBP病原菌以革兰氏阴性杆菌为主，其中主要致病菌为大肠杆菌；抗感染治疗首选第三代头孢菌素和第三代氟喹诺酮类药物；早期识别不典型SBP，积极预防感染，重视饮食护理和心理护理是预防护理的美键。     

乳果糖对肝硬化自发性腹膜炎患者肠黏膜屏障功能的影响

目的：探讨乳果糖对肝炎肝硬化自发性细菌性腹膜炎（SBP）患者肠黏膜屏障功能的影响。方法：将54例肝炎肝硬化SBP患者随机分为标准治疗对照组和乳果糖治疗组。检测SBP患者乳果糖治疗前后对照组及健康组均口服糖分子探针乳果糖、甘露醇,采用高压液相色谱-示差法,评估患者肠黏膜屏障功能。结果：治疗前肝硬化SBP、无菌性腹水（SA）组尿LAC／MAN均显著高于健康对照组（均P〈0．001）。治疗1周后乳果糖治疗组尿LAC／MAN较对照组下降明显（P〈0.01）。结论：（1）肝炎肝硬化SBP患者存在肠黏膜屏障功能异常;（2）乳果糖短期治疗可以显著改善肝炎肝硬化SBP患者肠黏膜屏障功能。     

Model for End-Stage Liver Disease Score Predicts Development of First Episode of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis

ObjectiveTo examine whether baseline model for end-stage liver disease (MELD) score in patients with cirrhosis and ascites predicts the future development of first spontaneous bacterial peritonitis (SBP) episode.MethodsA retrospective case-control study was performed at three academic centers to select patients admitted with first SBP episode (cases) and those with ascites admitted for decompensation without SBP (controls). Medical records from these centers were reviewed between January 1, 2008, and December 31, 2013. Cases and controls were matched (1:2) for age, sex, and race. Conditional logistic recession models were built to determine whether baseline MELD score (within a month before hospitalization) predicts first SBP episode.ResultsOf 697 patients (308, 230, and 159 from centers A, B, and C, respectively), cases and controls were matched in 94%, 89%, and 100% at three respective centers. In the pooled sample, probability of SBP was 11%, 31%, 71%, and 93% at baseline MELD scores less than or equal to 10, from 11 to 20, from 21 to 30, and greater than 30, respectively. Compared with MELD score less than or equal to 10, patients with MELD scores from 11 to 20, 21 to 30, and greater than 30 had six- (3- to 11-), 29- (12- to 69-), and 115- (22- to 598-) folds (95% CI) risk of SBP, respectively. Based on different MELD score cutoff points, MELD score greater than 17 was most accurate in predicting SBP occurrence. Analyzing 315 patients (152 cases) with available data on ascitic fluid protein level controlling for age, sex, and center, MELD score but not ascitic fluid protein associated with first SBP episode with respective odds ratios of 1.20 (1.14 to 1.26) and 0.88 (0.70 to 1.11).ConclusionBaseline MELD score predicts first SBP episode in patients with cirrhosis and ascites.     

Spontaneous bacterial peritonitis is associated with high levels of interleukin-6 and its secondary mediators in ascitic fluid

Abstract. We investigated 37 patients with ascites and liver cirrhosis in order to examine whether on the basis of correlation of cytokines and acute phase proteins of the ascitic fluid, prognosis of spontaneous bacterial peritonitis can be made. Significantly enhanced levels of interleukin-6, as well as acute phase reactants a-l-antitrypsin and C-reactive protein were found in the ascitic fluid of patients with spontaneous bacterial peritonitis. The levels of tumour necrosis factor alpha (TNF-α), neopterin, interleukin 2–receptor and granu-locyte-macrophage colony stimulating factor were higher in patients with spontaneous bacterial peritonitis, but without statistical significance, whereas no differences were found between the interferon gamma, interleukin-2 and interleukin-1 levels. In addition, interleukin-6, TNF-α and neopterin levels were found to correlate significantly with the outcome of the disease. These findings show that acute phase reaction occurs in the ascitic compartment in correlation with the development of spontaneous bacterial peritonitis.