肝硬化并发自发性腹膜炎的临床特点及病原学分析

目的研究分析肝硬化并发自发性腹膜炎（SBP）的临床特点及病原学情况。方法选择2010年10月至2013年10月在我科接受治疗的肝硬化并发SBP患者347例作为研究对象。患者中急性发病者192例，隐匿发病者155例，分析肝硬化并发SBP患者的临床特点，腹水培养后病原菌情况，以及主要菌种的耐药率。结果除腹水增加外，急性发病组在畏寒、发热、腹痛、腹胀、黄疸加重、腹部压痛、肌紧张以及反跳痛等方面的比例均显著高于隐匿发病组，差异均有统计学意义（P〈0．05）。347例患者中共有96例腹水的病原菌培养呈阳性，共分离出病原菌100株。其中革兰氏阴性菌占87．00％。主要为大肠埃希菌及肺炎克雷伯菌。革兰氏阳性菌占10．00％真菌占3．00％。革兰氏阴性杆菌对于常用的抗菌药物普遍表现出耐药性，其中产ESBLs大肠埃希菌以及肺炎克雷伯菌等对于第3代的头孢菌素均敏感，此类菌株可报告对其耐药。结论针对肝硬化并发SBP患者，临床治疗时应及时予以腹水的病原菌培养及药敏试验，通过药敏结果作出科学正确的指导，最终有助于提升治疗成功率，值得临床重视。

Clinical feature and etiology analysis of hepatic cirrhosis combined with spontaneous bacterial peritonitis

Objective To study clinical feature and etiology of hepatic cirrhosis （HC） combined with spontaneous bacterial peritonitis （SBP）. Methods 347 cases of HC combined with SBP in our department from October 2010 to October 2013 were selected as research object, with 192 cases of acute onset and 155 cases of hidden onset. Analyzed clinical characteristics, pathogenic bacteria in ascites after cultivating, and drug resistance rates of main strains. Results In addition to the increase of ascites, the rates of chills, fever, abdominal pain, abdominal distention, aggravated jaundice, abdominal tenderness, muscle tension and rebound tenderness in acute onset group were significantly higher than those in hidden onset group, with statistically significant differences （all P 〈 0.05）. Bacterial culture was positive of ascites in 96 patients, with a total of 100 strains of pathogenic bacteria isolated. Gram negative bacteria accounted for 87.00%, which were mainly e.coli and klebsiella pneumoniae; gram positive bacteria accounted for 10.00%; fungi accounted for 3.00%. Gram-negative bacilli showed resistance to commonly used antimicrobial agents, in which e.coli and klebsiella pneumoniae producing ESBLs were sensitive to third-generation cephalosporins, such strains could be reported on its resistance. Conclusions For patients with HC combined with SBP, clinical treatment should include pathogenic bacteria culture and drug sensitive test of ascites, and a scientific correct guidance can be made according to drug susceptibility results, which helps to improve treatment success rate in the end, worthy of clinical application.