失代偿期肝硬化腹水合并自发性腹膜炎患者的临床观察  

Clinical characteristics of patients with decompensated hepatocirrhosis ascites complicated with spontaneous peritonitis

作　　者：李红玲[1] 瞿婷婷[2] 李世波[1] 

机构地区：[1]温州医科大学附属舟山医院感染性疾病科,浙江舟山316000 [2]浙江大学医学院附属第一医院感染性疾病科,浙江杭州310006

出　　处：《中华医院感染学杂志》2015年第14期3252-3254,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81371859)

摘　　要：目的了解失代偿期肝硬化腹水合并自发性腹膜炎患者的临床特点,为该疾病的治疗提供研究数据。方法对147例失代偿期肝硬化腹水合并自发性腹膜炎患者的腹水标本进行病原菌检测和药敏试验,并检测产超广谱β-内酰胺酶(ESBLs)菌株,治疗后评价治疗效果;采用SPSS20软件进行统计分析。结果从腹水标本中共检出病原菌161株,其中革兰阴性菌114株占70.81%,以大肠埃希菌、肺炎克雷伯菌为主,革兰阳性菌33株占20.49%,以表皮葡萄球菌、粪肠球菌为主,真菌14株占8.70%,以白色假丝酵母菌为主;大肠埃希菌对美罗培南、亚胺培南的耐药率均为0,产ESBLs大肠埃希菌对常见抗菌药物的耐药率高于非产ESBLs大肠埃希菌;治疗后,显效41例、好转51例、无效55例,治疗总有效率为62.59%。结论自发性腹膜炎的临床表现不明显,进展快、预后差、病死率高,其主要病原菌为革兰阴性菌,对于失代偿期肝硬化腹水合并自发性腹膜炎的治疗,应进行腹水标本的采集和病原菌药敏试验,合理选用敏感抗菌药物,有利于获得满意的治疗效果。OBJECTIVE To understand the clinical characteristics of the patients with decompensated hepatocirrhosis ascites complicated with spontaneous peritonitis so as to provide guidance for treatment of the disease.METHODS A total of 147 patients with decompensated hepatocirrhosis ascites complicated with spontaneous ascites were enrolled in the study,then the pathogens were detected,the drug susceptibility testing was performed,the extended-spectrumβ-lactamase（ESBLs）-producing strains were detected,the curative effect was evaluated,and the statistical analysis was performed with the use of SPSS20 software.RESULTS Totally 161 strains of pathogens have been isolated from the ascites specimens,including 114（70.81%）strains of gram-negative bacteria,33（20.49%）strains of gram-positive bacteria,and 14（8.70%）strains of fungi;the Escherichia coli and Klebsiella pneumoniae were the predominant species of gram-negative bacteria;the Staphylococcus epidermidis and Enterococcus faecalis were dominant among the gram-positive bacteria;the Candida albicans was the major species of fungi.The drug resistance rates of the E.coli to meropenem and imipenem were 0;the drug resistance rates of the ESBLs-producing E.coli strains to the commonly used antibiotics were higher than those of the non-ESBLs-producing E.coli strains.After the treatment,41 cases were effective,51 cases were improved,and 55 cases were ineffective,with the total effective rate of 62.59%.CONCLUSIONThe clinical manifestations of the spontaneous peritonitis are untypical,with the progression rapid,the prognosis poor,the mortality rate high.The gram-negative bacteria are dominant among the pathogens.As for the treatment of the patients with decompensated hepatocirrhosis ascites complicated with spontaneous ascites,it is necessary to collect the ascites specimens and perform the drug susceptibility testing and reasonably use sensitive antibiotics so as to achieve satisfied curative effect.

关 键 词：失代偿期肝硬化腹水 自发性腹膜炎 药敏试验 耐药性 

分 类 号：R572.2[医药卫生—消化系统]