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目的探讨自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)的发病因素、诊治和预后相关因素。方法收集2009年5月—2012年10月新疆医科大学一附院收治的SBP病例共118例,对其易患因素、临床表现、实验室检查、细菌培养及治疗与转归进行回顾性分析,统计方法运用χ2检验。结果在118例SBP患者中有53例存在易患因素,最常见为消化道出血。有典型腹膜炎临床表现者仅5例,腹胀为最常见的症状。47例出现并发症,包括肝肾综合征、肝性脑病、电解质紊乱、消化道出血及其他部位感染。血常规中白细胞计数升高者22例,腹水细菌培养阳性9例(7.6%),其中革兰阴性菌占66.7%。使用了第3代头孢菌素及喹诺酮类抗生素及输注白蛋白治疗,治疗有效75例。肝肾功能改善及并发症减少可以改善SBP的预后。结论 SBP是失代偿期肝硬化及重症肝炎的严重并发症,临床表现不典型,临床表现难以诊断SBP,腹水穿刺检查是诊断SBP有效而客观的方法,对怀疑SBP的患者,如无腹腔穿刺禁忌证,应尽可能行腹水穿刺检查。对于确诊或者怀疑SBP者,应该早期进行治疗。SBP的预后与肝肾功能及伴有并发症有密切关系。
Objective To investigate the pathogenesis, diagnosis and prognosis of spontaneous bacterial peritonitis (SBP). Methods A total of 118 patients with SBP who were admitted to First Affiliated Hospital of Xinjiang Medical University from May 2009 to October 2012 were retrospectively analyzed for susceptibility factors, clinical manifestations, laboratory tests, bacterial culture, treatment and prognosis, Statistical methods using χ2 test. Results Of the 118 SBP patients, 53 had predisposing factors, the most common being gastrointestinal bleeding. Only 5 cases of clinical manifestations of typical peritonitis, abdominal distension is the most common symptoms. 47 cases of complications, including liver and kidney syndrome, hepatic encephalopathy, electrolyte disorders, gastrointestinal bleeding and other parts of the infection. Twenty-two patients with elevated white blood cell count in blood and 9 patients with bacterial culture in ascites (7.6%), of which Gram-negative bacteria accounted for 66.7%. The use of third-generation cephalosporins and quinolone antibiotics and albumin infusion therapy, the effective treatment of 75 cases. Improvement of hepatic and renal function and reduction of complications can improve the prognosis of SBP. Conclusion SBP is a serious complication of decompensated cirrhosis and severe hepatitis. The clinical manifestations are not typical and the clinical manifestations are difficult to diagnose SBP. Ascitic fluid puncture is an effective and objective method for the diagnosis of SBP. SBP patients without abdominal puncture Contraindications, ascites should be performed as far as possible. For those with confirmed or suspected SBP, early treatment should be performed. The prognosis of SBP and liver and kidney function and complications are closely related.