重症肝炎并发自发性细菌性腹膜炎的临床分型及意义  

Clinical classification of spontaneous bacterial peritonitis in patients with severe viral hepatitis and its signifieance

作　　者：任星峰[1] 赵甫涛[1] 葛娅[1] 杨群[1] 李敬安[1] 张李琳[1] 

机构地区：[1]广州军区武汉总医院感染内科,430070

出　　处：《中国医师进修杂志（内科版）》2009年第2期5-7,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的分析重症肝炎并发自发性细菌性腹膜炎（SBP）的临床特征，探讨其临床分型及意义。方法回顾性分析120例重症肝炎并发SBP患者的临床表现，并根据初始出现的主要临床症状、体征进行临床分型。结果SBP临床分型：普通型50例（41．7％），无症状型19例（15．8％），肝昏迷型16例（13．3％），顽固性腹水型21例（17．5％），休克型14例（11．7％）。肝昏迷型及休克型腹水细菌培养阳性率较高，存活率较低。结论重症肝炎并发SBP临床表现不典型，将其分成5型，有利于提高临床医师对SBP的认识，早期诊断，减少漏诊。肝昏迷型及休克型SBP预后差，临床上应高度重视。Objective To analyze the clinical characteristic of spontaneous bacterial peritonitis （SBP） in patients with severe viral hepatitis, and explore its clinical classification and significance. Methods A retrospective research of 120 cases of SBP associated with severe viral hepatitis was performed, and main clinical symptoms and physical signs appeared at the early onset were classified and explored. Results Clinical manifestations of SBP in patients with severe viral hepatitis included 5 types, which were conventional type（41.7%, 50/120）, symptomless type（ 15.8%, 19/120）, hepatic coma type（ 13.3%, 16/120）, refractory ascites type （ 17.5%, 21/120）, and shock type （ 11.7%, 14/120）. The germiculture positive rate of SBP with hepatic coma type and shock type were relatively high, and the survival rate of these patients were low. Conclusions Clinical manifestations of SBP in patients with severe viral hepatitis may be atypical, and its classification help to enhancing the understanding and early diagnosis of SBP, and decreasing missed diagnosis. The prognosis of SBP in patients with hepatic coma type and shock type was poor, and then it must be taken high into account more than ever before in the clinical practice.

关 键 词：肝炎 病毒性 人 细菌感染 腹膜炎 临床分型 

分 类 号：R575.2[医药卫生—消化系统] R512.6[医药卫生—内科学]