乙肝肝硬化腹水并发自发性腹膜炎临床特点及护理对策  

Analysis of clinical characteristics and nursing strategies of patients with ascites complicated with spontaneous peritonitis in liver cirrhosis of hepatitis B

作　　者：王瑞[1] 彭玉龙[2] 王成宝 WANG Rui;PENG Yulong;WANG Chengbao(Linyi People's Hospital,Linyi,Shandong 276000,China;Infectious Disease Teaching and Research Office,Shandong Medical College,Linyi,Shandong 276000,China)

机构地区：[1]临沂市人民医院肝胆外科,山东临沂276000 [2]临沂市人民医院感染科,山东临沂276000 [3]山东医学高等专科学校传染病教研室,山东临沂276000

出　　处：《社区医学杂志》2024年第24期842-846,共5页Journal Of Community Medicine

基　　金：山东省中医药科技发展计划项目(2013-333)。

摘　　要：目的分析乙肝肝硬化腹水合并自发性腹膜炎(SBP)患者的临床特点并制定相应的护理对策。方法选取2018-03-01-2023-03-01临沂市人民医院乙肝肝硬化腹水患者120例作为研究对象,根据有无并发SBP分为SBP组和非SBP组,每组各60例。收集2组患者的部分症状、体征、性别、年龄、城乡分布、是否合并糖尿病、是否合并肝性脑病、是否合并消化道出血、是否有SBP病史、肝功能、血常规、Child-Pugh分级、C-反应蛋白(CRP)、降钙素原(PCT)等临床资料。分别采用t检验、非参数检验及χ^(2)检验对患者的临床资料进行统计分析。结果一般资料比较,糖尿病史(χ^(2)=9.624,P=0.002)、上消化道出血病史(χ^(2)=4.183,P=0.041)、SBP病史(χ^(2)=3.927,P=0.048)和Child-Pugh分级(χ^(2)=6.828,P=0.033)为乙肝肝硬化腹水并发SBP的影响因素;临床症状体征方面比较,腹痛(χ^(2)=19.740,P<0.001)、发热(χ^(2)=12.810,P<0.001)和巩膜黄染(χ^(2)=7.603,P=0.006)为乙肝肝硬化腹水并发SBP的影响因素;在肝功能方面比较,SBP组丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)中位数和四分位数分别为49.00(36.83,62.90)、46.60(34.55,60.03)U/L,非SBP组ALT、AST中位数和四分位数分别为45.85(38.25,68.95)、46.00(39.05,51.75)U/L,2组比较差异无统计学意义,Z值分别为-0.042、-0.108,均P>0.05。2组血清总胆红素(TBIL)中位数和四分位数分别为51.65(30.20,67.98)、32.60(27.48,41.03)μmol/L,2组比较差异有统计学意义,Z=-3.813,P<0.05;血清白蛋白(ALB)分别为(26.97±2.30)、(27.99±2.20)g/L,差异有统计学意义,t=2.410,P<0.05;感染相关指标对比,SBP组白细胞计数(WBC)、中性粒细胞计数(NEUT)、血小板计数(PLT)取对数后值分别9.72±0.20、9.58±0.22、10.85±0.14,PCT值为(1.20±0.86)μg/L,非SBP组WBC、NEUT、PLT取对数后值分别9.60±0.10、9.48±0.15、10.91±0.08,PCT值为(0.27±0.04)μg/L,2组比较差异有统计学意义,t值分别为4.390、2.912、2.571、7.6Objective To analyze the clinical characteristics of hepatitis B cirrhosis with ascites combined with spontaneous peritonitis(SBP)and formulate corresponding nursing countermeasures.Methods A total of 120 patients with ascites from hepatitis B cirrhosis in Linyi People's Hospital from March 1,2018,to March 1,2023 were selected as the study objects,and were divided into SBP group and non-SBP group according to the presence or absence of SBP,with 60 cases in each group.Clinical data such as symptoms,signs,gender,age,urban and rural distribution,diabetes mellitus,hepatic encephalopathy,gastrointestinal hemorrhage,history of SBP,liver function,blood routine,Child-Pugh grade,C-reactive protein(CRP)and procalcitonin(PCT)were collected.The clinical data of the patients were statistically analyzed using t-test,non-parametric test,and chi-square test.Results Comparison of general data showed that history of diabetes(χ^(2)=9.624,P=0.002),history of gastrointestinal bleeding(χ^(2)=4.183,P=0.041),history of SBP(χ^(2)=3.927,P=0.048)and Child-Pugh classification(χ^(2)=6.828,P=0.033)were the influencing factors of ascites complicated with SBP in hepatitis B cirrhosis.In terms of clinical symptoms and signs,abdominal pain(χ^(2)=19.740,P<0.001),fever(χ^(2)=12.810,P<0.001)and scleral yellow staining(χ^(2)=7.603,P=0.006)were also the influencing factors of ascites complicated with SBP in hepatitis B cirrhosis.In liver function comparison,the median and quartile of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in SBP group were 49.00(36.83,62.90)and 46.60(34.55,60.03)U/l respectively.The median and quartile of ALT and AST in the non-SBP group were 45.85(38.25,68.95)and 46.00(39.05,51.75)U/l respectively,and there was no significant difference between the two groups,with Z values of-0.042 and-0.108,both P>0.05.The median and quartile of serum total bilirubin(TBIL)in the two groups were 51,65(30.20,67.98)and 32.60(27.48,41.03)μmol/l respectively,and the Z-value of the two groups was-3.813,P<0.01.Serum albumin

关 键 词：乙肝肝硬化 自发性腹膜炎 临床特点 护理对策 

分 类 号：R473.6[医药卫生—护理学]