Akriviadis E A, Runyon B A
Liver Unit, University of Southern California School of Medicine, Los Angeles.
Gastroenterology. 1990 Jan;98(1):127-33. doi: 10.1016/0016-5085(90)91300-u.
To prospectively assess the value of an algorithm in differentiating spontaneous from secondary bacterial peritonitis, we performed serial paracenteses in 43 episodes of ascitic fluid infection (28 spontaneous and 15 secondary) in 40 patients. The algorithm involved identification of (a) secondary peritonitis associated with gut perforation, based on previously proposed criteria in patients with neutrocytic ascites (ascitic fluid total protein greater than 1 g/dl, glucose less than 50 mg/dl, and lactate dehydrogenase greater than the upper limit of normal for serum) and (b) separation of spontaneous from secondary peritonitis (unassociated with perforation) based on the response of the ascitic fluid cell count to antibiotic therapy. The perforation criteria had 100% sensitivity in detecting episodes of actual gut perforation; their specificity, however, was low (45%). After 48 h of treatment the concentration of ascitic fluid neutrophils was below the baseline pretreatment value in all episodes of spontaneous peritonitis but in only two thirds of the patients with secondary peritonitis. This algorithm is useful in (a) identifying patients who have infected ascites associated with perforation of an intraabdominal viscus, and (b) differentiating spontaneous from nonperforation secondary peritonitis on the basis of the response of the ascitic fluid cell count to appropriate antibiotic therapy. The optimal time for repeat paracentesis in patients with infected ascites appears to be 48 h after initiation of treatment.
为前瞻性评估一种鉴别自发性细菌性腹膜炎和继发性细菌性腹膜炎的算法的价值，我们对40例患者的43次腹水感染发作（28例自发性和15例继发性）进行了系列腹腔穿刺术。该算法包括：(a) 根据先前针对中性粒细胞性腹水患者（腹水总蛋白大于1 g/dl、葡萄糖小于50 mg/dl且乳酸脱氢酶高于血清正常上限）提出的标准，识别与肠道穿孔相关的继发性腹膜炎；(b) 根据腹水细胞计数对抗生素治疗的反应，区分自发性腹膜炎和继发性腹膜炎（与穿孔无关）。穿孔标准在检测实际肠道穿孔发作时敏感性为１００％；然而，其特异性较低（45％）。治疗48小时后，所有自发性腹膜炎发作患者腹水中性粒细胞浓度均低于治疗前基线值，但继发性腹膜炎患者中只有三分之二如此。该算法有助于：(a) 识别患有与腹腔内脏器穿孔相关的感染性腹水的患者；(b) 根据腹水细胞计数对适当抗生素治疗的反应，区分自发性腹膜炎和非穿孔性继发性腹膜炎。对于感染性腹水患者，重复腹腔穿刺术的最佳时间似乎是治疗开始后48小时。
