肝衰竭合并自发性细菌性腹膜炎的临床分析  

Clinical analysis of spontaneous bacterial peritonitis in patients with liver failure

作　　者：陈曦 王移欢 段绍琪 刘凤君[1] CHEN Xi;WANG Yi-huan;DUAN Shao-qi;LIU Feng-jun(Department of Infection,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China)

机构地区：[1]川北医学院附属医院感染科,四川南充637000

出　　处：《川北医学院学报》2021年第4期445-448,共4页Journal of North Sichuan Medical College

基　　金：四川省科技厅科技支撑计划项目(2015SZ0049)。

摘　　要：目的:探讨肝衰竭并发自发性细菌性腹膜炎(SBP)患者的临床特点,为该病的早期诊断及治疗提供参考。方法:回顾性分析115例肝衰竭并发SBP患者的临床资料,包括症状体征、实验室检查及预后等。结果:115例患者中,体温正常者占53.04%,低热者占17.39%,中度发热者占13.91%,高热者15.65%;腹胀者占73.91%,轻微腹痛者占42.61%;腹部体征轻,主要表现为轻压痛、腹肌张力稍高;主要并发症为肝性脑病、消化道出血、肝肾综合征。实验室检查结果显示,60.87%的患者外周血白细胞计数正常,29.57%的患者升高,少数患者降低;血液PCT为(1.35±3.00)ng/mL,且97.56%的患者升高;腹水常规检查中细胞计数多<300×10^(6)/L(68.09%),且以淋巴细胞为主(76.60%);17.02%的患者腹水PMN计数≥250×10^(6)/L。47例腹水细菌培养中阳性为5例(10.64%)。115例患者治愈37例(32.17%),好转30例(26.09%),无效48例(41.74%),死亡12例(10.43%)。结论:肝衰竭患者SBP的临床表现及实验室检查不典型,且预后差,临床工作中对于肝衰竭合并腹水的患者应警惕SBP的发生,早期抗感染治疗有利于改善预后。Objective:To explore the clinical characteristics of spontaneous bacterial peritonitis(SBP)in patients with liver failure,provide reference for the early diagnosis and treatment of the disease.Methods:The clinical data of 115 patients with liver failure complicated with SBP were analyzed retrospectively,including symptoms and signs,laboratory examination and prognosis.Results:Among 115 patients,53.04%had normal body temperature,17.39%had low fever,13.91%had moderate fever,and 15.65%had high fever.Abdominal distension was the main abdominal symptom(73.91%),followed by mild abdominal pain(42.61%).Abdominal signs were mild,mainly manifested as mild tenderness,slightly higher abdominal muscle tension.And the main complications were hepatic encephalopathy,gastrointestinal hemorrhage,hepatorenal syndrome.Laboratory examination:Most patients(60.87%)had normal peripheral white blood cell counts,only 29.57%of patients had elevated,and a few patients had decreased,PCT test was(1.35±3.00)ng/mL,97.56%of patients was elevated,the ascites routine examination showed that the cell count was mostly lower than 300×10^(6)/L(68.09%),and mainly lymphocytes(76.60%),polymorphonuclear neutrophils(PMN)number in ascites≥250×10^(6)/L in 17.02%of patients.Among 47 cases of ascites bacterial culture,5 cases(10.64%)were positive.Among 115 patients,37 cases were cured(32.17%),30 cases were improved(26.09%),48 cases were invalidated(41.74%),and 12 cases died.Conclusion:The clinical manifestations and laboratory tests of SBP in patients with liver failure are not typical,and the prognosis is poor.Patients with liver failure and ascites should be alert to the occurrence of SBP in clinical work.Early anti-infective treatment is beneficial to improve the prognosis.

关 键 词：肝衰竭 自发性细菌性腹膜炎 临床分析 

分 类 号：R575.3[医药卫生—消化系统] R572.2[医药卫生—内科学]