慢性肝衰竭并发自发性细菌性腹膜炎诊断标准探讨 朱研, 张长江, 毛青.doc

慢性肝衰竭并发自发性细菌性腹膜炎诊断标准探讨 朱研, 张长江, 毛青 第三军医大学第一附属医院 重庆 400038 摘要 目的：探讨慢性肝衰竭并发自发性细菌性腹膜炎(spontaneous bacterial peritonitis, SBP)的早期诊断标准。方法：回顾性分析我科2008.01～2011.05住院的慢性肝衰竭患者1003例，从中选取SBP者35例腹水多形核白细胞(polyreorphonuclear leucocyte，PMN)计数≥250×106/L者例，(whiteblood cell，WBC)≥250×106/L但不足A组标准者例WBC计数＜250×106/L但PMN比例≥50%者56例(C组)，不足C组标准者98例(D组)。对组患者抗生素治疗前后腹水WBCPMN计数以及患者预后等进行分析％()的患者腹水PMN计数低于250×106/L；B组患者腹水WBC计数较治疗前明显降低(P＜0.05)；C组及D组患者腹水WBC计数与治疗前相比，差异无统计学意义(P均＞0.05)。结论：腹水WBC计数≥250×106/L作为SBP的诊断标准更为合理。对慢性肝衰竭并发SBP者，建议抗感染疗程在7天以上。 关键词 肝衰竭；自发性细菌性腹膜炎；诊断标准 中图分类号 R572.2；R575.3；R44 Analysis of diagnostic criteria of spontaneous bacterial peritonitis in patients with chronic liver failure ZhuYan, ZhangChangjiang, MaoQing((Department of Infection, Southwest Hospital, Third M ilitary Medical University, Chongqing, 400038, China) 【Abstract】 Objective To study the diagnostic criteria of spontaneous bacterial peritonitis (SBP) in patients with chronic liver failure. Methods Totally 1003 inpatients with chronic liver failure in our department during 2008.012011.05 were enrolled. Among these patients, 385 patients complicated by SBP were chosen, 126 patients with aseitic fluid polymorphonuclear leucocyte(PMN)counts greater than or equal to 250×106/L(group A), then 105 patients with ascitic fluid white blood cell(WBC)counts greater than or equal to 250×106/L, but PMN counts less than 250×106/L(group B), and 56 patients with ascitic fluid WBC counts less than 250×106/L, but the proportion of ascitic fluid PMN greater than or equal to 50%( group C), the remaining 98 patients of non-group A, B or C(group D). Patients’ clinical data, ascitic fluid WBC or PMN counts before and after antibiotic treatment, and the prognosis of the four groups, etc were compared and analyzed. Results On the 7th day of antibiotic treatment, ascitic fluid PMN counts were controlled less than 250×106/L in 71.4%(20/28) patients of group A, and compared to pretherapy, aseitie fluid WBC counts were significantly different in p