肝硬化并发自发性腹膜炎临床特点分析

目的探讨延边地区肝硬化并发自发性细菌性腹膜炎（sBP）临床特点。方法回顾性分析延边大学附属医院2008年1月～2012年12月在本院住院的198例肝硬化并发SBP患者临床资料。结果发热77例（38．9％），腹膜刺激征101例（51．0％），压痛20例（10．1％），血白细胞高102例（51．5％），血中性粒细胞百分比高165例（83．3％）；腹水培养结果为大肠埃希菌3例（3／5），腹水细菌培养阳性率3．68％；并发肝性脑病39例，电解质紊乱36例，上消化道出血29例，肝肾综合征25例；治愈者126例（63．6％），好转26例（13．1％），死亡32例（16．2％），死于肝肾综合征11例（34．4％），上消化道出血10例（31．2％），肝性脑病8例（25％），感染性休克3例（9．4％），14例自动出院。结论临床表现多不典型，血中性粒细胞百分比升高较多见，诊断需靠腹水检查；治疗药物首选第三代头孢菌素，疗程为7～14d，同时给予保肝，输白蛋白或输血浆，利尿，必要时行腹腔冲洗术及腹腔内注入消炎药物。

Analysis of the clinical features of Hver cirrhosis complicated with spontaneous bacterial peritonitis

Objective To probe the clinical features of liver cirrhosis complicated with spontaneous bacterial peritonitis （SBP） in YaMbian area. Methods Retrospective analysis of the YaMbian University Hospital＇s 198 patients with the cases of liver Cirrhosis complicated with SBP in period of 2008-2012. Results 77 cases of fever （38.9%）, peritoneal irritation sign in 101 cases （51%）, 20 cases of tenderness （10.1%）, high white blood cells in 102 cases（51.5%）, neutrophil percent higher in 165 cases （83.3%）; the results of ascites were escherichia coli （3/5） in 3 cases, ascites bacterial culture positive rate was 3.68%;39 cases complicated with hepatic eneephalopathy, electrolyte disorder in 36 cases, 29 cases of upper gastrointestinal bleeding, 25 cases of hepatorenal syndrome; 126 cases were cured （63.6%）, improved in 26 cases （13.1%）, death of 32 cases （16.2%）, died of hepatorenal syndrome in 11 cases （34.4%）, 10 cases of upper gastrointestinal bleeding （31.2%）, 8 cases with hepatic encephalopathy （25%）, 3 cases of septic shock （9.4%）, 14 cases of discharge. Conclusion Atypical clinical manifestations, most of the higher percentage blood neutrophils, diagnosis needs to rely on the ascites; preferred drug is the third generation cephalosporins, treatment for 7-14 days, while liver protection, supplementation of albumin or plasma, diuresis, if necessary, do the peritoneal lavage and intraperitoneal injection of anti-inflammatory drugs