抗生素治疗原发性腹膜炎对肝硬化门脉血液动力学影响.docVIP

抗生素治疗原发性腹膜炎对肝硬化门脉血液动力学影响 　 作者：代文洁，孙妍，高云飞，赖少彤 【摘要】 　　目的 研究抗生素治疗60例肝硬化原发性腹膜炎患者对肝硬化门脉血流的影响。方法 用抗生素治疗肝硬化原发性腹膜炎患者，根据临床资料对患者行Child-Pughs分期，用彩色多普勒检测治疗前、后门脉主干内径、门脉主干、门脉左支矢状部血流速度;并检测血浆内毒素水平(LPS)。结果 治疗后内毒素水平明显低于治疗前(Plt;0.05);门脉主干及门脉左支矢状部血流速度较治疗前明显增加(Plt;0.05)，但门脉内径无明显变化(Pgt;0.05)。结论 抗生素治疗肝硬化原发性腹膜炎可降低内毒素水平，增加门静脉血流，改善肝脏功能，使再出血率降低。 【关键词】 原发性腹膜炎 内毒素 门静脉血流 　　Abstract:　Objective to investigate influence of cirrhotic patients accompanying by spontaneous bacterial peritonitis treated by antibiotics on levels of LPS and dynamics of portal vein circulation.Methods the sixty cases of cirrhotic patients accompanying by spontaneous bacterial peritonitis(SBP) treated with antibiotics for 10～14 days，the levels of LPS in serum were assayed before and after treatment, the changes of diameter of the common portal vein(DPV)、velocity of blood flow(VPF)of the common portal vein and UPV were determined before and after treatment.Results before treatment the levels of LPS in serum was significantly lower than that of LPS in the serum (Plt;0.05) and velocity of blood flow of common portal vein and upv before treatment were markedly lower than those after treatment (Plt;0.05), The difference for the diameter of portal vein (PVD) is not significant (Pgt;0.05).Conclusion the cirrhotic patients with SBP treated by antibiotics fallen the level of LPS in serum and improved dynamics of portal vein circulation, to lower down the ratio of rebleeding. 　　Keywords:spontaneous bacterial peritonitis （SBP）；lipopolysaccharide endotoxin （LPS）；portal vein flow 　　细菌感染，特别是原发性腹膜炎[1]是肝硬化晚期患者常见的并发症。肝硬化患者肠道细菌过度繁殖，肠道的动力障碍以及肠道通透性改变增加肠道细菌移位机会。研究证明：门脉高压、细菌移位及免疫功能低下导致感染的主要原因。目前，感染与上消化道出血的关系倍受关注[2～4]。而感染诱导细胞因子产生、释放加重肝细胞损伤，增加门脉压力。因此，积极和有效地防治感染、细菌移位，预防感染相关并发症是亟待解决的课题。本文研究抗生素治疗肝硬化原发性腹膜炎患者对门静脉压力的影响。 　　1　材料与方法 　　1.1　病人的选择　纳入标准：本组选自我院2002-9至2006-7的住院肝硬化腹水经细菌培养阳性的原发性腹膜炎患者60例：男性39，女性21例。年龄(27-83)岁，平均(51.4±7.65)岁。按Child-Puph’s分级：B级23例、C级37例。一周内未用抗生素。排除标准：合并原发性肝癌门静脉血栓、继发性肝癌、糖尿病及非肝病性门脉高压。疗效标准：根据1988年福州全国腹水学术会制定的标准[5] 　　1.2　治疗方法　根据体外细菌培养结果