亚胺培南联合白介素2腹腔注射治疗肝硬化自发性细菌性腹膜炎疗效观察

目的:观察亚胺培南联合白介素2腹腔注射治疗肝硬化自发性细菌性腹膜炎的疗效。方法:本院2014年1月-2015年1月收治的40例乙型肝炎肝硬化并自发性细菌性腹膜炎患者为研究对象,按照随机数字表法将其分为治疗组和对照组,每组20例。在内科抗感染治疗的基础上,对照组患者单纯采取亚胺培南腹腔注射治疗,治疗组患者采取亚胺培南联合白介素2腹腔注射治疗,观察比较两组患者的临床治疗效果及并发症发生情况。结果:治疗1周后,治疗组的总有效率为95%(19/20)明显高于对照组的70%(14/20);肺部感染、肝肾综合征、肝性脑病、消化道出血等并发症总发生率15%(3/20)明显低于对照组35%(7/20),差异均有统计学意义(P0.05)。结论:亚胺培南联合白介素2治疗肝硬化自发性细菌性腹膜炎疗效显著,能降低并发症发生率。     

头孢曲松钠联合左氧氟沙星治疗肝硬化并自发性细菌性腹膜炎的疗效观察

目的观察头孢曲松钠联合左氧氟沙星治疗肝硬化并自发性细菌性腹膜炎的疗效。方法将72例肝硬化并发自发性细菌性腹膜炎随机分为治疗组37例和对照组35例,治疗组给予头孢曲松钠2g,静脉注射,2次/d,左氧氟沙星注射液0.3 g,静滴,2次/d;对照组给予头孢哌酮/舒巴坦钠2g,静滴,2次/d。疗程14～21 d,观察两组治疗后的疗效。结果治疗组总有效率为89.19%,对照组总有效率为68.57%,治疗组疗效明显优于对照组(P<0.05)。结论头孢曲松钠联合左氧氟沙星治疗肝硬化并自发性细菌性腹膜炎疗效显著。     

亚胺培南与美罗培南治疗肝硬化自发性细菌性腹膜炎临床对照研究

目的评价两种碳青酶烯类抗生素亚胺培南与美罗培南治疗肝硬化自发性细菌性腹膜炎的疗效和安全性。方法对2006年1月至2008年1月武警北京总队第二医院消化科89例肝硬化自发性细菌性腹膜炎患者,采用单盲随机对照方法分别接受亚胺培南与美罗培南治疗,亚胺培南组45例,美罗培南组44例,观察两组患者临床表现、腹水减退时间、细菌学培养结果及不良反应。临床分离菌株分别进行亚胺培南、美罗培南体外药敏试验。结果经腹水、血、尿培养共获得108株病原菌,治疗后亚胺培南组病原菌清除率为87.9%,美罗培南组为86.0%(P>0.05);两组临床有效率分别为77.8%和70.5%(P>0.05);亚胺培南组体温由(39.2±0.8)℃降至(37.1±0.6)℃,时间为(1.9±0.7)d;美罗培南组由(38.9±0.8)℃降至(37.2±0.7)℃,时间为(3.2±0.9)d;两者差异具有统计学意义(P=0.002),亚胺培南组平均疗程亦较美罗培南组短[(6.6±2.3)d对(7.8±1.8)d,P=0.039],两种药物使用中不良反应发生均较少而轻(11.60%对9.50%,P>0.05)。结论亚胺培南与美罗培南治疗肝硬化自发性腹膜炎安全有效;二者抗菌谱及临床疗效相近,亚胺培南在退热时间及平均疗程上优于美罗培南。     

莫西沙星联合头孢哌酮／舒巴坦治疗呼吸机相关性肺炎的疗效评价

目的比较莫西沙星联合头孢哌酮／舒巴坦与亚胺培南／西司他丁治疗呼吸机相关性肺炎的有效性和安全性。方法采用随机对照设计，观察莫西沙星联合头孢哌酮／舒巴坦与亚胺培南／西司他丁治疗63例呼吸机相关性肺炎的临床疗效和不良反应。结果莫西沙星联合头孢哌酮／舒巴坦组32例，治疗有效率为87．50％，细菌清除率为86．67％；亚胺培南／西司他丁组31例，治疗有效率为83．87％，细菌清除率为84．62％；两组问差异无显著性；两组不良反应发生率均为6．7％。结论莫西沙星联合头孢哌酮／舒巴坦治疗呼吸机相关性肺炎与亚胺培南／西司他丁，同样临床疗效确切、安全性高，可作为VAP的经验性抗感染药。     

腹腔灌洗后局部应用抗生素治疗肝硬化合并自发性腹膜炎72例临床观察

目的 探讨肝硬化合并自发性腹膜炎的治疗方法.方法 对72例肝硬化合并自发性腹膜炎患者进行治疗,将腹水放出,同时向腹腔补充同等量复方乳酸钠溶液,每次灌洗量3 000～5 000 ml,或使混浊腹水变清为止,灌洗完成后将头孢曲松和甲硝唑注入腹腔,隔日1次.与84例对照组进行对比.结果 腹腔灌洗后局部应用抗生素治疗肝硬化合并自发性腹膜炎,病情缓解时间明显优手静脉应用抗生素;治疗组死亡17例(23.6%),对照组死亡35例(42.7%),P＜0.05,有显著性差异.结论 腹腔灌洗后局部应用抗生素治疗肝硬化合并自发性腹膜炎,病情缓解快、并发症少,并能提高疗效、改善预后.     

腹水超滤浓缩-细菌过滤回输腹腔治疗肝炎肝硬化合并自发性细菌性腹膜炎的临床疗效分析

目的 评估腹水超滤浓缩-细菌过滤回输腹腔技术治疗肝炎肝硬化合并自发性细菌性腹膜炎患者的临床疗效.方法 110例肝炎肝硬化合并自发性细菌性腹膜炎患者随机分为研究组和对照组,两组患者均采用保肝、利尿、对症、支持及静脉滴注抗生素等常规治疗,疗程2周.研究组在常规治疗基础上,采用腹水超滤浓缩-细菌过滤回输腹腔治疗;对照组在常规治疗基础上,采用腹腔穿刺放液治疗.结果 治疗后研究组腹水蛋白及补体C3水平明显高于对照组(P＜0.01),研究组血清白蛋白水平明显高于对照组(P＜0.01),研究组临床疗效明显好于对照组(P＜0.01).结论 腹水超滤浓缩-细菌过滤回输腹腔技术治疗肝炎肝硬化合并自发性细菌性腹膜炎患者的临床疗效明显好于腹腔穿刺放液治疗.     

胸腺肽联合头孢哌酮/舒巴坦治疗老年不动杆菌下呼吸道感染研究

目的 观察胸腺肽联合头孢哌酮/舒巴坦治疗老年不动杆菌下呼吸道感染患者临床疗效、细菌清除率及二重感染情况.方法 随机选择64例临床确诊为老年不动杆菌下呼吸道感染者,分成胸腺肽联合头孢哌酮/舒巴坦为治疗组32例,单用头孢哌酮/舒巴坦治疗为对照组32例.观察两组的临床疗效,细菌清除率、二重感染率、化验室指标改善情况等.结果 不动杆菌对头孢哌酮-舒巴坦、哌拉西林-他唑巴坦、亚胺培南的敏感率较高63.0％～83.3％,其他抗生素敏感率均减低,小于60％.治疗组总有效率78.1％,明显高于对照组的53.1％,差异有统计学意义(P＜0.05).治疗后治疗组痰培养不动杆菌清除率81.3％,较对照组的63％有明显升高,差异有统计学意义(P＜0.05).治疗后治疗组二重感染率14.6％,较对照组41.3％有明显降低,差异有统计学意义(P＜0.05).结论 胸腺肽可改善机体的免疫功能、炎症反应,联合头孢哌酮/舒巴坦治疗老年不动杆菌下呼吸道感染具有协同作用.胸腺肽联合头孢哌酮/舒巴坦治疗组化验室指标改善明显,细菌清除率明显提高,二重感染率明显降低,提高了临床治疗有效率.     

降钙素原在肝硬化合并细菌性腹膜炎中的临床意义

目的研究降钙素原(PCT)在乙型肝炎肝硬化失代偿期合并细菌性腹膜炎中的临床意义。方法选取我院2015年1月至2016年12月期间收治的肝硬化腹水患者62例。其中合并自发性腹膜炎的患者28例为腹膜炎组,未合并腹膜炎的患者34例为单纯腹水组,在我院健康体检者30名作为对照组。患者均接受保肝、利尿、补充白蛋白及对症支持治疗。腹膜炎组在此基础上应用头孢哌酮舒巴坦钠抗感染治疗,或使用依诺沙星治疗,如效果不明显则应用亚胺培南西司他丁钠治疗,此后根据腹水培养结果与药敏试验结果调整用药。在入院第1日、3日及7日采集静脉血(对照组入院当天采血)进行血清PCT定量检测。结果入院第1日,腹膜炎组、单纯腹水组及对照组的血清PCT水平比较差异有统计学意义(P0.05),其中自发性腹膜炎组患者的PCT水平显著高于单纯腹水组和对照组。治疗第1日、3日、7日时,腹膜炎组PCT均高于单纯腹水组(P0.05);入院第7日时单纯腹水组基本接近对照组(P0.05),而腹膜炎组仍高于对照组(P0.05)。治疗后第1日、3日及7日时,腹膜炎组痊愈/好转共17例,未愈/恶化共11例,治愈/好转组的血清PCT水平均显著低于未愈/恶化组(P0.05),差异有统计学意义(P0.05)。结论动态检测血清PCT水平不仅有助于肝硬化患者早期自发性腹膜炎的诊断,抗生素及时调整,并对其预后评估有一定临床价值。     

抑酸药物对肝硬化患者自发性细菌性腹膜炎发病率的影响

目的 探讨抑酸药物对肝硬化患者并发自发性细菌性腹膜炎(SBP)发病率的影响.方法 回顾性分析2002年1月～2011年12月我院收治的365例肝硬化患者的临床资料.根据使用抑酸药物情况分成3组:A组162例,使用质子泵抑制剂;B组118例,使用组胺H2受体拮抗剂;C组85例,未使用抑酸药物,分析3组患者自发性细菌性腹膜炎发病率的差异.结果 365例肝硬化患者中,发生自发性细菌性腹膜炎94例,发生率为25.8％ (94/365).A组患者发生自发性细菌性腹膜炎54例,发生率32.7％ (54/165);B组患者发生自发性细菌性腹膜炎25例,发生率为21.2％ (25/118);C组患者发生自发性细菌性腹膜炎16例,发生率18.8％ (16/85).A组自发性细菌性腹膜炎发生率明显高于B组和C组(P＜0.05),而B组和C组之间比较差异无统计学意义(P＞0.05).结论 质子泵抑制剂增加肝硬化患者并发自发性细菌性腹膜炎的风险,而组胺H2受体拮抗剂对自发性细菌性腹膜炎的发生没有明显影响.     

腹腔置管注药并引流治疗干酪型结核性腹膜炎的疗效观察

目的探讨腹腔置管注药并引流治疗干酪型结核性腹膜炎的临床疗效。方法干酪型结核性腹膜炎病人60例,分为两组,对照组应用抗结核药物全身化疗;实验组应用腹腔置管注药并引流(异烟肼和利福平注射液)+全身化疗。观察两组病人发热、腹痛、腹胀、呕吐、便秘等症状缓解时间;腹腔分房及包裹性积液消退程度;腹部包块及腹腔淋巴结肿大消退程度。结果治疗4周时,病人症状缓解时间、腹腔分房及包裹性积液消退程度和腹部包块及腹腔淋巴结肿大消退程度,两组比较差异有统计学意义(P<0.01)。结论应用异烟肼和利福平注射液腹腔置管注药并引流治疗技术可减轻腹腔粘连包裹,缓解患者症状,减少肠梗阻及结核性化脓性腹膜炎的发生机会,提高好转率及治愈率。     

清开灵联合头孢哌酮钠/舒巴坦钠治疗老年肺气肿合并感染的疗效观察

目的观察清开灵联合头孢哌酮钠/舒巴坦钠治疗老年肺气肿合并感染的临床疗效。方法 58例老年肺气肿合并感染患者随机分为两组。治疗组33例和对照组30例。对照组(28例)予以头孢哌酮钠/舒巴坦钠治疗,治疗组(30例)在对照组基础上加用清开灵治疗。观察和比较两组临床疗效,症状缓解时间、体温恢复正常时间及住院时间。结果治疗组治疗总有效率为90.0%,对照组治疗总有效率为78.6%,两组比较有显著性差异(P<0.05);治疗组治疗后症状缓解时间、体温恢复正常时间及住院时间均明显优于对照组(P<0.05)。结论清开灵联合头孢哌酮钠/舒巴坦钠治疗老年肺气肿合并感染疗效显著,安全可靠,值得临床推广应用。     

头孢噻肟钠与培菲康联合治疗肝硬化自发性腹膜炎的疗效分析

目的分析头孢噻肟钠联合培菲康治疗肝硬化自发性腹膜炎(spontaneous bacterial peritonitis,SBP)的临床疗效和不良反应。方法选取西安市第四医院就诊的84例肝硬化SBP患者,依据治疗方案不同分为:研究组41例,应用头孢噻肟钠联合培菲康治疗;对照组43例,仅应用头孢噻肟钠治疗。两组疗程均为14 d,比较两组患者临床疗效及不良反应的差异。结果与对照组相比,研究组的显效率、有效率及总有效率显著较高(P0.05),发热、腹痛、腹胀、腹部压痛及腹水菌群等临床表现缓解时间明显较短(P0.05),且肝功能衰竭、低血压性休克及病死率显著减少(P0.05)。结论头孢噻肟钠联合培菲康治疗肝硬化SBP疗效显著,不良反应少。     

肝炎肝硬化并发自发性细菌性腹膜炎治疗探讨

目的探讨肝炎肝硬化并发自发性细菌性腹膜炎的治疗。方法147例肝炎肝硬化并发自发性细菌性腹膜炎患者行综合治疗:1积极支持治疗;2舒普深抗感染,每日4克,共3周;3每次放腹水后使用罗氏芬1克,腹腔注射。同期另118例肝炎肝硬化并发自发性细菌性腹膜炎患者,接受积极支持治疗和舒普深抗感染,每日4克,共2周。结果与对照组比,抗感染3周疗程加放腹水组患者腹水消退快,总胆红素下降明显,腹腔感染控制较彻底,一年后自发性细菌性腹膜炎复发率显著降低(P<0.05)。结论肝炎肝硬化并发自发性细菌性腹膜炎的抗感染治疗疗程要长,适时放腹水可提高疗效。     

枯草杆菌二联活菌肠溶胶囊联合枸橼酸莫沙必利治疗乙肝肝硬化合并小肠细菌过度生长疗效探究

目的:探究枯草杆菌二联活菌肠溶胶囊联合枸橼酸莫沙必利治疗乙肝肝硬化合并小肠细菌过度生长(SIBO)疗效。方法:选取潍坊市人民医院感染科2020年10月-2021年4月收治的68例失代偿期乙肝肝硬化患者,行葡萄糖甲烷氢呼气试验诊断乙肝肝硬化合并SIBO 48例,随机分为试验组(24例)和对照组(24例),对照组给予保肝、低蛋白饮食、抗病毒等常规治疗,试验组在常规治疗的基础上加用枯草杆菌二联活菌肠溶胶囊(500 mg/次,3次/饭后)联合枸橼酸莫沙必利(5 mg/次,3次/饭前)治疗,观察2组治疗前后葡萄糖甲烷氢呼气试验、血清谷草转氨酶(AST)、谷丙转氨酶(ALT)、内毒素、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)、肝功能Child-Pugh及腹部不适变化。结果:48例患者中有44例完成试验,有4例退组,其中试验组有1例出现消化道出血,1例未规律服药,对照组有2例出现肝性脑病(HE)。治疗后,试验组呼气试验转阴率为63.6%,明显高于对照组的9.1%(P<0.01);腹部不适减轻总有效率为100.0%,显著高于对照组68.5%(P<0.01);内毒素、TNF-α...     

The value of ascitic fluid polymorphonuclear cell count determination during therapy of spontaneous bacterial peritonitis in patients with liver cirrhosis

BACKGROUND/AIMS: Spontaneous bacterial peritonitis is one of the most common complications attending the onset of ascites in patients with liver cirrhosis. The aim of this study was to demonstrate whether it is possible, on the basis of ascitic fluid polymorphonuclear cell count in patients with liver cirrhosis and spontaneous bacterial peritonitis, to determine the optimal duration of cefotaxime therapy, as the most frequently applied empirical therapy, and possibly anticipate the disease recurrence. METHODOLOGY: In 16 patients with alcoholic liver cirrhosis and confirmed diagnosis of spontaneous bacterial peritonitis, cefotaxime therapy was administered 2g t.i.d. during 5 days. Before the therapy, at 48 hours, 5 days and 15-20 days after the cefotaxime therapy was started, in all patients with spontaneous bacterial peritonitis diagnostic abdominal paracentesis was performed, each time determining the ascitic fluid polymorphonuclear cell count together with microbiological analysis. RESULTS: In the course of the "primary" spontaneous bacterial peritonitis attack, 3 patients died (18.8%). In 4 patients the recurrence of spontaneous bacterial peritonitis was observed within 15-20 days after therapy was discontinued. Two patients died during the therapy of spontaneous bacterial peritonitis recurrence. After 48 hours of therapy, 11 patients with the "primary" spontaneous bacterial peritonitis attack were without any symptoms (68.8%). Out of these 11, 10 patients (62.5%) had the ascitic fluid polymorphonuclear cell count lower than 250/mm3. After 5 days of therapy, 12 patients (75%) were free of symptoms, and the number of ascitic fluid polymorphonuclear cell count < 250/mm3 was still found in 10 (62.5%) patients. No association between the presence of symptoms 48 hours after the therapy and the recurrence of spontaneous bacterial peritonitis was established. A significant association was found between the ascitic fluid polymorphonuclear cell count determined 48 hours after the therapy and the recurrence of spontaneous bacterial peritonitis. A recurrence occurred in only 1 patient with the number of ascitic fluid polymorphonuclear cell count < 250/mm3, 48 hours after the therapy was started. A recurrence of spontaneous bacterial peritonitis occurred in all the patients who had an ascitic fluid PMN cell count > or = 250/mm3, 48 hours after the therapy was started. CONCLUSIONS: By monitoring the ascitic fluid PMN cell count it seems to be possible to determine the efficacy and optimal duration of cefotaxime therapy in patients with spontaneous bacterial peritonitis when it is of most importance that the number of ascitic fluid PMN cell count should decrease below 250/mm3 during the therapy.     

Spontaneous bacterial peritonitis in Saudi Arabian patients with non-alcoholic liver cirrhosis

BACKGROUND/AIMS: Spontaneous bacterial peritonitis is a frequent and serious complication of liver cirrhosis. Its prevalence varies from one survey to another. There are only very few reports of its occurrence among Arab patients. METHODOLOGY: We studied 115 Saudi Arabian patients with cirrhotic ascites in the Gizan region, an area of hyperendemic hepatitis B, over a 2-year period. RESULTS: Of these patients 12 (10.4%) had at least 1 episode of culture-positive spontaneous bacterial peritonitis (group A), an additional 34 (29.6%) had culture-negative neutrocytic ascites. The occurrence of spontaneous bacterial peritonitis was more frequent in males but was not influenced by the severity of liver disease or age. The overall mortality was 13.9%, however, only 1 patient died of spontaneous bacterial peritonitis-related cause. The remaining deaths were due to other complications of hepatic failure and portal hypertension. The low clinical threshold for treatment and the use of effective broad-spectrum antibiotics have reduced the mortality due to spontaneous bacterial peritonitis. There were a total of 56 recurrent episodes of infection in the patients. Of these episodes 46 occurred among 29 patients with spontaneous bacterial peritonitis and 10 among 62 patients with no infection during the index admissions. CONCLUSIONS: Prophylactic therapy against spontaneous bacterial peritonitis is a feasible strategy in reducing the frequency of recurrent peritonitis and should be recommended in these patients.     

Clinical presentation and prevalence of spontaneous bacterial peritonitis in patients with cryptogenic cirrhosis and features of metabolic syndrome.

BACKGROUND: Nonalcoholic steatohepatitis (NASH) may progress to cirrhosis. The prevalence and clinical relevance that spontaneous bacterial peritonitis may have in complicating ascites due to NASH-related cirrhosis have yet to be defined. METHODS: Among 611 cases of cirrhosis-associated ascites, 45 patients with cryptogenic cirrhosis were retrospectively identified. Of these, 36 patients and a control group of subjects with viral- associated ascites were followed up and compared in a case control study. Information on the onset of ascites, with or without spontaneous bacterial peritonitis, history of risk factors for multimetabolic syndrome, and serological and ascitic laboratory data were compared between groups. RESULTS: Spontaneous bacterial peritonitis occurred significantly more often in patients with cryptogenic cirrhosis than in equally symptomatic viral controls. The prevalence of obesity, diabetes and spontaneous bacterial peritonitis was significantly higher in patients with cryptogenic cirrhosis. Although liver function was similar in both groups, cryptogenic cirrhosis patients had lower aminotransferase levels. Multivariate analysis identified diabetes, juvenile obesity and spontaneous bacterial peritonitis as independent factors associated with ascites due to cryptogenic cirrhosis. CONCLUSIONS: Features suggestive of NASH are more frequently observed in patients with ascites and cryptogenic cirrhosis than in age- and sex-matched ascitic patients with well-defined viral etiology. Ascites may be a presenting symptom of NASH-related cirrhosis, and affected patients have a twofold greater risk of spontaneous bacterial peritonitis.     

Analysis of clinical course and prognosis of culture-positive spontaneous bacterial peritonitis and neutrocytic ascites

The clinical significance and prognosis of culture-negative neutrocytic ascites in cirrhotic patients is a controversial topic. In the present study, the clinical and humoral presentation and the short-and long-term prognosis were analyzed in 36 patients with cirrhosis and culture-positive spontaneous bacterial peritonitis and in 28 patients with cirrhosis and ascitic fluid polymorphonuclear count greater than 250/mm³, a negative ascitic fluid culture, and without previous antibiotic therapy. On admission there were no significant differences between groups related to age, sex, alcoholism, fever, abdominal pain, serum albumin, serum urea, serum creatinine, Child-Pugh score, polymorphonuclear count, and total protein concentration in ascitic fluid. A greater frequency of positive blood culture was found in patients with spontaneous bacterial peritonitis (15/21 vs 2/18) (P<0.001). Mortality during the first episode was 36% in patients with spontaneous bacterial peritonitis and 46% in patients with culture-negative neutrocytic ascites (NS). Mortality during follow-up was high and survival probability at 12 months was 32% in spontaneous bacterial peritonitis and 31% in culture-negative neutrocytic ascites. The probability of recurrence at 12 months was 33% in spontaneous bacterial peritonitis and 34% in culture-negative neutrocytic ascites. Our results show that spontaneous bacterial peritonitis and culture-negative neutrocytic ascites are variants of the same disease with a high mortality and poor prognosis.     

终末期肝病并发自发性腹膜炎患者血小板计数的变化及其临床意义

目的：探讨终末期肝病并发自发性腹膜炎患者血小板计数的变化及其临床意义。方法：对266例并发自发性腹膜炎的终末期肝病患者进行回顾性分析,研究对象分为失代偿期肝硬化组、慢性重型肝炎组。观察两组患者血小板计数在腹膜炎发作前、腹膜炎发生时、腹膜炎治愈后的变化,以同组中未并发自发性腹膜炎的患者为对照。结果：失代偿期肝硬化和慢性重型肝炎并发自发性腹膜炎患者血小板计数在腹膜炎发生时下降,腹膜炎治愈后回升（P均〈0.01）。结论：血小板计数变化可作为失代偿期肝硬化和慢性重型肝炎并发自发性腹膜炎诊断和治疗的一项辅助参考指标。