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目的分析终末期肝病患者并自发性腹膜炎的临床特征。方法以重型肝炎、肝硬化及原发性肝癌患者为研究对象,详细记录其临床症状、体征及实验室检查,根据腹水培养及药敏试验结果选择合适的抗生素,观察其疗效及转归并判断其预后。结果终末期肝病并自发性腹膜炎(SBP)109例,占所观察532例肝病患者的20.49%,其中,重型肝炎占46.53%(47/101),肝硬化占14.61%(52/356),原发性肝癌占13.33%(10/75),分别死亡27例、4例和3例;外周血白细胞>10.0×109/L者29例(26.61%),中性粒细胞分类>0.7者62例(56.88%),体温>38℃者21例,腹水培养阳性率为19.26%,其中大肠埃希菌占培养阳性者占38.10%,治疗有效率为66.06%。结论终末期肝病并SBP临床表现不典型,存在脾功能亢进,白细胞减少,腹水培养阳性率低,因此以腹水白细胞、多形核细胞及血白细胞分类作为诊断SBP的主要依据。重型肝炎并SBP发生率高于肝硬化及肝癌,同时三者的病死率均高于不并发SBP者。因此,预防SBP的发生,给予敏感药物积极有效治疗SBP对提高终末期肝病患者疗效及改善预后有积极意义。
Objective To analyze the clinical features of patients with end-stage liver disease and spontaneous peritonitis. Methods The patients with severe hepatitis, cirrhosis and primary liver cancer were studied, and their clinical symptoms, signs and laboratory tests were recorded in detail. According to the results of ascites culture and susceptibility test, the suitable antibiotics were selected and their efficacy and prognosis were observed and judged Prognosis. Results 109 cases of end-stage liver disease with spontaneous peritonitis (SBP) accounted for 20.49% of the 532 cases of liver disease observed. Among them, severe hepatitis accounted for 46.53% (47/101), cirrhosis accounted for 14.61% (52/356) The incidence of primary hepatocellular carcinoma was 13.33% (10/75), with 27 cases died, 4 cases and 3 cases respectively. Twenty-nine cases (26.61%) had peripheral blood leukocytes> 10.0 × 109 / L and 62 cases had neutrophil classification> 0.7 (56.88%), body temperature> 38 ℃ 21 cases, the positive rate of ascites culture was 19.26%, of which Escherichia coli accounted for 38.10% of the positive culture, the treatment efficiency was 66.06%. Conclusion The clinical manifestations of end-stage liver disease and SBP are not typical, there is hypersplenism, leukopenia, ascites culture positive rate is low, so the classification of ascites leukocytes, polymorphonuclear cells and white blood cells as the main basis for the diagnosis of SBP. Severe hepatitis and SBP incidence higher than cirrhosis and liver cancer, while the three were higher than the non-fatality SBP. Therefore, to prevent the occurrence of SBP, to give sensitive drugs active and effective treatment of SBP to improve the efficacy of patients with end-stage liver disease and improve prognosis of positive.