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目的探讨肝硬化并发自发性细菌性腹膜炎(SBP)的临床特征、致病原及治疗愈后情况。方法回顾性分析62例肝硬化并发SBP患者的临床特征、实验室检查结果、腹水培养、药敏情况及预后等。结果肝硬化并SBP的临床表现以发热、腹胀、腹痛、腹部压痛为主要表现,而典型的腹膜刺激征仅见于约半数的患者。腹水白细胞及PMN明显升高。腹水细菌培养阳性率低,大肠杆菌和其他革兰阴性杆菌为主要致病菌,药物敏感试验对第3代头孢菌素药物敏感。合并SBP患者病死率明显高于无SBP患者。结论肝硬化并发SBP患者临床表现大多数不典型,病原菌以大肠杆菌多见,腹水PMN比值是诊断SBP的较可靠指标;肝硬化并发SBP严重影响预后。
Objective To investigate the clinical features, pathogens and prognosis of patients with cirrhosis complicated with spontaneous bacterial peritonitis (SBP). Methods A retrospective analysis of 62 patients with cirrhosis complicated with SBP clinical features, laboratory tests, ascites culture, drug sensitivity and prognosis. Results The clinical manifestations of cirrhosis and SBP were mainly fever, bloating, abdominal pain and abdominal tenderness, while typical peritoneal irritation was found in only about half of patients. Ascites leukocytes and PMN were significantly higher. Ascites bacterial culture positive rate is low, Escherichia coli and other gram-negative bacilli as the main pathogens, drug sensitivity test for third-generation cephalosporin drug-sensitive. The mortality of patients with SBP was significantly higher than those without SBP. Conclusions Most of the clinical manifestations of patients with cirrhosis complicated with SBP are not typical, the pathogens are more common in Escherichia coli, ascites PMN ratio is a more reliable indicator of the diagnosis of SBP; cirrhosis complicated with SBP seriously affect the prognosis.