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目的为及时救治肝硬化合并的自发性细菌性腹膜炎(SBP),以提出早期诊断及影响预后的因素。方法对107例病人进行临床研究,观察年龄、性别、肝硬化病因、SBP发生率及院内感染率、细菌学检查及药敏试验,并设置对照组比较肝功能、血常规、腹水常规、B超、Child-pugh分级和并发症。结果肝硬化病因以HBV感染为主(83.2);男性居多,同期住院病人中合并SBP者为21.6%,其中医院内感染率16.8%腹水培养致病菌阳性率14%,以单菌株G-杆菌为多数(66.7%)。药敏试验提示耐药率超过50%的依次为青霉素、氨曲南、氧氟沙星。与对照组比较ChildC级例数明显增多(P<0.05);腹水WBC计数明显升高(P<0.05),Rivanlta试验(+)率显著增加(P<0.001)血清ALB值有降低的趋势(P=0.089)。末梢血WBC计数及腹水Rivanlta试验(+)与Child分级、血清BUN呈正相关,与ALB呈负相关。结论SBP多为单菌株、G-杆菌感染,青霉素及奎诺酮类耐药。早期诊断性腹腔穿刺非常必要。ChildC级、低ALB血症是SBP的罹患因素。
The purpose of timely treatment of cirrhosis complicated by spontaneous bacterial peritonitis (SBP), to make early diagnosis and prognosis factors. Methods A total of 107 patients were studied. Age, sex, etiology of liver cirrhosis, incidence of SBP, nosocomial infection rate, bacteriological examination and drug susceptibility test were observed. Liver function, blood routine, ascites routine, B- , Child-pugh classification and complications. Results The main cause of cirrhosis was HBV infection (83.2). The majority of men were hospitalized with SBP in 21.6% of hospitalized patients in the same period. Among them, the infection rate in hospital was 16.8%, and the positive rate of pathogenic bacteria in ascites culture was 14% The majority (66.7%). Drug susceptibility tests suggest that resistance rates of more than 50% followed by penicillin, aztreonam, ofloxacin. Compared with the control group, ChildC level increased significantly (P <0.05), ascites WBC count increased significantly (P <0.05), Rivanlta test (+) increased significantly (P <0.001) = 0.089). WBC count of peripheral blood and ascites Rivanlta test (+) were positively correlated with Child’s grade and serum BUN, but negatively correlated with ALB. Conclusion SBP mostly single strain, G-bacteria infection, penicillin and quinolone resistance. Early diagnostic paracentesis is very necessary. Child Class C, hypoalbuminemia is a contributing factor to SBP.