肝炎肝硬化合并自发性细菌性腹膜炎诊疗分析（附76例病例）

目的探讨肝炎肝硬化合并自发性细菌性腹膜炎（SBP）的临床诊疗要点。方法回顾性分析某院2007年2月-2010年1月收治的76例肝炎肝硬化合并SBP患者的临床资料。结果76例肝炎肝硬化合并SBP患者中，体温＞37℃者占67.11%（51例）；43.42%（33例）的患者无腹痛、压痛及反跳痛。腹腔积液常规检查：白细胞计数＞0.3×109/L者占38.16%（29例），多形核白细胞＞25％者占55.26%（42例）。血培养阳性16例（21.05%），腹腔积液培养阳性19例（25.00%）。经保肝、利尿、支持和合理的抗感染等综合治疗，患者治愈、好转率达76.32%（58例）。结论肝炎肝硬化合并SBP患者临床表现大多不典型，细菌培养阳性率低，早期腹腔积液检查和动态观察外周血白细胞计数对诊断有意义。积极有效诊断和治疗SBP是取得满意疗效的关键。

Diagnosis and treatment of cirrhosis with spontaneous bacterial peritonitis (with 76 cases analysis)

Objective To evaluate clinical diagnosis and treatment of cirrhosis with spontaneous bacterial peritonitis （SBP）. Methods Clinical data of 76 cases of cirrhosis with SBP in hospitalized patients between February 2007 and January 2010 were analyzed retrospectively. Results Of 76 patients, 67. 11% （51 cases） had temperature 〉37℃, 43. 42% （33 cases） had no abdominal pain, rebound tenderness and tenderness. Routine examination on abdominal cavity fluid showed that white blood cell count of 38. 16~patients （29 cases） were 〉0. 3 × 10^9/L, polymorphonuclear leukocyte of 55.26% （42 cases） patients were ~25%, 21.05% （16 cases） had positive blood cul- ture, 25.00% （19 cases） had positive culture of abdominal cavity fluid. After patients received general treatment, such as liver protection, diuresis, supportive treatment and rational antimicrobial use, the total cure and improve- ment rate reached up to 76. 32% （58 cases）. Conclusion Clinical manifestations of cirrhosis with SBP is atypical, positive rate for bacterial culture is low, early abdominal cavity fluid examination and dynamic observation on peripheral white blood cell count is significant for the diagnosis. The key to the ideal curative effect on SBP is active diagnosis and treatment.