92例重型肝炎并发自发性细菌性腹膜炎的诊断与治疗

目的探讨重型肝炎并发自发性细菌性腹膜炎(SBP)的诊断和抗生素使用。方法回顾性分析2002年7月~2005年6月间收治的92例并发SBP的重型肝炎患者的临床资料。结果92例患者中,发热72例(78.26%),腹胀85例(92.39%),腹痛38例(41.30%),反跳痛35例(38.04%),83例(90.21%)外周血中性粒细胞(PMN)分类≥0.75,40例(45.98%)腹水PMN计数≥250个/mm3,79例(90.80%)腹水PMN比值≥0.50,11例(12.00%)腹水细菌培养阳性,共分离出细菌17株,G-杆菌占52.9%(9/17),其对头孢曲松、头孢哌酮、头孢他啶、左旋氧氟沙星及泰能敏感,对丁胺卡那、氧哌嗪青霉素敏感性较低。临床治疗显示,联合使用头孢他啶和甲硝唑效果较好,并较少出现继发真菌感染。结论重型肝炎并发SBP患者的临床表现不典型,腹水培养阳性率低,外周血和腹水PMN比值是诊断SBP比较可靠的参数。治疗SBP,可首选二联使用头孢他啶与甲硝唑,疗程约10~14日。

Diagnosis and therapy of 92 severe hepatitis patients with spontaneous bacterial peritonitis

Objective To increase the diagnostic level of spontaneous bacterial peritonitis (SBP) in the severe hepatitis and to suitably apply antibiotic for enhancing the curable rate.Methods A retrospective analysis of clinical data was performed in 92 severe hepatitis cases with SBP from July 2002 to June 2005.Results Main clinical manifestations were as follows:fever(78.26%),abdominal distention (92.39%),abdominal pain(41.30%),bounced pain(38.0%) in the abdomen. 90.2% of polymorphonuclear (PMN) cell ration in the peripheral blood was higher than 0.75. In ascitic fluid, 45.98% of PMN cell count were greater than 250/mm3 and 90.80% of PMN cell ration was more than 0.50. Positive culture of scities was 12%. 52.9% of the isolated microorganisms were G-which were sensitive to ceftriaxione,cefobis, fortum, levofloxacin and tienam.It was more effecive to apply fortum with flacyl that induced less following fungi infection. Conclusion Clinical manifestations in SBP may be atypical. The bacterial positive rate was low in ascites. PMN cell ration is a more reliable parameter for diagnosing SBP. It is recommended combining fortum with flacyl for about 10 to 14 days to cure SBP.