Amarapurkar D N, Viswanathan N, Parikh S S, Kalro R H, Desai H G
Department of Gastroenterology, BYL Nair Charitable Hospital, Bombay.
J Assoc Physicians India. 1992 Apr;40(4):236-8.
To assess the prevalence of spontaneous bacterial peritonitis (SBP), ascitic fluid cell count, and ascitic fluid culture by conventional method and by bedside inoculation in blood culture bottles were performed in 31 consecutive patients of liver cirrhosis. Seven (22.58%) patients had ascitic fluid polymorphonuclear count (PMN) more than 500/mm. Ascitic fluid culture by conventional method was negative in all the patients, while in 4 patients culture was positive by bedside inoculation method. Six of 7 patients with SBP or its variant were in Child class C. Clinical features in these patients were abdominal pain (5 patients), fever (4) and encephalopathy (2); serum bilirubin level was 6.8 +/- 5.5 mg/dl, serum albumin 1.98 +/- 0.2 g/dl, prothrombin index 59.8 +/- 12.2%, ascitic fluid protein 0.78 +/- 0.24 g/dl. Three of 7 patients with SBP or its variant expired during hospital stay; the other 4 patients recovered after appropriate antibiotic therapy. We conclude that SBP is a serious complication in patients of liver cirrhosis with ascites. Ascitic fluid PMN count and bedside inoculation of blood culture bottles with ascitic fluid are sensitive indicators of SBP. Hence they should be performed routinely for early detection of SBP.
对31例肝硬化患者采用传统方法及在血培养瓶中进行腹水床边接种的方法，评估自发性细菌性腹膜炎（SBP）的患病率、腹水细胞计数及腹水培养情况。7例（22.58%）患者腹水多形核细胞计数（PMN）超过500/mm。所有患者采用传统方法进行的腹水培养均为阴性，而采用床边接种法有4例患者培养呈阳性。7例SBP或其变异型患者中有6例属于Child C级。这些患者的临床特征为腹痛（5例）、发热（4例）和脑病（2例）；血清胆红素水平为6.8±5.5mg/dl，血清白蛋白1.98±0.2g/dl，凝血酶原指数59.8±12.2%，腹水蛋白0.78±0.24g/dl。7例SBP或其变异型患者中有3例在住院期间死亡；其他4例患者经适当抗生素治疗后康复。我们得出结论，SBP是肝硬化腹水患者的一种严重并发症。腹水PMN计数及腹水在血培养瓶中的床边接种是SBP的敏感指标。因此，应常规进行这些检查以早期发现SBP。
