Zhou Zhi, Lai Ning, Zhang Quan-hai, Guo Yuan, Huang Chang-wu, Zhang Da-zhi, Ren Hong
Department of Infectious Diseases, the Second Affiliated Hospital of Chongqing University of Medical Sciences, Chongqing 400010, China.
Zhonghua Gan Zang Bing Za Zhi. 2004 Jun;12(6):350-2.
To improve the diagnosis and treatment level of spontaneous bacterial peritonitis (SBP) in the patients with advanced liver disease, get better curative effect and prognosis.
Registered the body temperature, symptoms and signs in the abdomen, and blood routine test, the polymorphonuclear (PMN) cell count, and ascites culture in the patients with cirrhosis and fulminant hepatitis. These patients were given supporting therapies including use plasma and albumin as well as antibiotics treatment according to drug sensitivity or empiric. Changes of the body temperature, symptoms and signs were used to evaluate the effect of therapy.
186 of 275 inward patients with end-stage liver disease during this period were considered as SBP by ascites culture or clinical experience with various degree symptoms and signs such as pain, distention, higher tension and touch pain in the abdomen. Infective rate was 67.6%. Among them 138 patients had abnormal body temperature more than 37.4 degrees C. 106 patients with leukocyte count in the peripheral blood more than 10 x 10(9)/L; 137 patients with PMN more than 80% in differential cell count; 103 patients with PMN more than 250/mm(3) in ascites. Only 29 patients were culture positive. 82 patients were cured, 17 patients with improvement, 18 patients with inefficacy or deterioration. 42 patients died of hepatic-renal failure and 27 patients died because of upper alimentary tract bleeding, respectively.
Signs and symptoms of SBP were atypical in the patients with end-stage liver disease. Ascites culture positive rate was not high. Early diagnosis and proper use antibiotics according to culture and empirics were important to increase effect and improve prognosis
提高晚期肝病患者自发性细菌性腹膜炎（SBP）的诊治水平，获得更好的疗效及预后。
对肝硬化及暴发性肝炎患者记录体温、腹部症状和体征、血常规、多形核（PMN）细胞计数及腹水培养情况。给予这些患者支持治疗，包括使用血浆和白蛋白，并根据药敏或经验给予抗生素治疗。通过体温、症状和体征的变化评估治疗效果。
在此期间收治的275例晚期肝病患者中，186例经腹水培养或临床经验判断为SBP，伴有不同程度的腹痛、腹胀、腹压升高及触痛等症状和体征。感染率为67.6%。其中138例患者体温异常超过37.4℃；106例外周血白细胞计数超过10×10⁹/L；137例中性粒细胞分类计数超过80%；103例腹水中性粒细胞超过250/mm³。仅29例培养阳性。82例治愈，17例好转，18例无效或病情恶化。分别有42例患者死于肝肾衰竭，27例患者死于上消化道出血。
晚期肝病患者SBP的症状和体征不典型。腹水培养阳性率不高。早期诊断并根据培养结果及经验合理使用抗生素对提高疗效及改善预后至关重要。
