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 Analysis of Post-hepatitis Cirrhosis Complicated with Spontaneous Bacterial Peritonitis

Objective To evaluate the diagnosis and treatment of post-hepatitis cirrhosis complicated with spontaneous bacterial peritonitis（SBP）cases and the efficacy of cefoperazone and sulbactam combined with levofloxacin in the treatment of cirrhotic patients with SBP.Methods From January 2004to December 2009,the clinical data from 54cases of SBP after cirrhosis were analyzed.The patients underwent the treatment of cefoperazone sulbactam combined with levofloxacin.The therapeutic effect was observed.Results The main clinical manifestations were fever and abdominal pain,and about half of the patients had the typical peritoneal irritation.Only a few patients had elevated peripheral white blood cells（WBC）.The WBC count,abdominal effusion polymorphonuclearcyte count and bacteria cul-tivation were the indexes of diagnosis of SBP.Conclusion The clinical features of post-hepatitis cirrhosis complicated with SBP are not typical.The main pathogenic bacteria is G-bacilli.In the early diagnosis and treatment,cefoperazone sulbactam combined with levofloxacin is effective.