重症肝炎患者发生自发性细菌性腹膜炎的临床特征与病原学分析  

Clinical characteristics of severe hepatitis patients complicated with spontaneous bacterial peritonitis and etiological analysis

作　　者：邢丽[1] 郑翠玲[1] 马风妹[1] 吴燕[1] 袁红艳[1] 

机构地区：[1]滨州市人民医院感染二科,山东滨州256600

出　　处：《中华医院感染学杂志》2016年第6期1271-1273,共3页Chinese Journal of Nosocomiology

基　　金：山东省自然科学基金资助项目(ZR2009CL018)

摘　　要：目的了解重症肝炎发生自发性细菌性腹膜炎(SBP)的临床特点及病原菌分布,为疾病的治疗提供依据。方法分析2010年6月-2015年6月医院75例重症肝炎合并自发性细菌性腹膜炎患者的临床特征,采集患者腹水送检,采用WITEK-2Compact进行菌种鉴定,观察SBP的诱因,所得数据采用SPSS15.0软件进行分析。结果 75例患者存在腹胀71例占94.67%;患者腹水常规检查:白细胞计数>0.5×109/L有44例占58.67%,多形核白细胞>0.25×109/L有65例占86.67%;腹水病原菌培养阳性患者47例阳性率62.67%;SBP主要诱因与呼吸系统、消化系统、泌尿系统感染等有相关性;75例患者共送检腹水标本共培养出病原菌35株,其中革兰阳性菌11株占31.43%,革兰阴性菌24株占68.57%,革兰阳性菌以肠球菌属所占比率最大,为17.14%,革兰阳性菌以大肠埃希菌所占比率最大,为31.43%。结论积极预防患者呼吸系统、消化系统感染,对腹水迅速增加,利尿药效果差者予以重视,以尽早确诊SBP及尽早治疗,提高疗效。OBJECTIVE To investigate the clinical characteristics of the severe hepatitis complicated with spontaneous bacterial peritonitis（SBP）and analyze the distribution of pathogens so as to provide guidance for clinical treatment.METHODS A total of 75 severe hepatitis patients complicated with spontaneous bacterial peritonitis who were treated in the hospital from Jun 2010 to Jun 2015 were enrolled in the study,and the clinical characteristics of the enrolled patients were analyzed.The pathogens isolated from the ascites specimens were identified by using WITEK-2Compact,the predisposing factors for the SBP were observed,and the statistical analysis of data was performed with the use of SPSS15.0software.RESULTS Of the 75 patients,71（94.67%）had abdominal distension.The ascites routine examination showed that 44（58.67%）patients were with the white blood cell counts more than 0.5×109/L,and 65（86.67%）patients were with the polymorphonuclear leukocyte counts more than0.25×109/L.The ascites specimens were cultured positive in 47 patients,with the positive rate of 62.67%.The major predisposing factors for the SBP included the respiratory system,digestive system,and urinary system infections.Totally 35 strains of pathogens were isolated from the submitted ascites specimens of the 75 patients,of which 11（31.43%）were gram-positive bacteria,and 24（68.57%）were gram-negative bacteria;Enterococcus spp was dominant among the gram-positive bacteria,accounting for 17.14%;Escherichia coli was the predominant species of the gram-negative bacteria,accounting for 31.43%.CONCLUSIONIt is necessary to actively prevent the respiratory system and digestive system infections and pay high attention to the rapid increase of ascites and effect of diuretics so as to confirm and treat the SBP as early as possible and improve the clinical efficacy.

关 键 词：重症肝炎 自发性细菌性腹膜炎 病原菌 感染 

分 类 号：R575.1[医药卫生—消化系统]