CAJ | 학술논문

目的：探讨慢加急性肝衰竭患者合并自发性腹膜炎（SBP）的早期诊断和治疗。方法将慢加急性肝衰竭108例患者分成3组：A 组38例，患者病毒性重症肝炎，尚无 SBP 指征。B 组36例，重症肝炎患者治疗过程中疗效欠佳（反复腹水生长或腹水控制不理想）。C 组34例，治疗过程中出现发热、腹痛、腹肌紧张，腹膜刺激征阳性，腹水迅速增长，利尿剂无效。分别观察各组患者 PCT、CRP 及内毒素的水平变化，腹水培养的阳性率、耐药率及临床治疗转归率。结果3组患者 PCT、CRP 及内毒素水平检测，C 组与 A 组之间比较差异有统计学意义（P ＜0．05）。B 组同 C 组之间比较差异无统计学意义（P ＞0．05）。细菌性腹膜炎的发生分别为 A 组10例（26．32％），B 组25例（69．44％）及 C 组32例（94．12％）。腹水培养的阳性病原菌为41株，39株耐药。抗感染治疗后，67例细菌性腹膜炎好转36例（53．73％），治愈15例（22．39％），死亡16例（23．88％）。结论慢加急性肝衰竭患者出现自发性细菌性腹膜炎的发病率较高，早期发现可以控制病情，提高治愈率。
목적：탐토만가급성간쇠갈환자합병자발성복막염（SBP）적조기진단화치료。방법장만가급성간쇠갈108례환자분성3조：A 조38례，환자병독성중증간염，상무 SBP 지정。B 조36례，중증간염환자치료과정중료효흠가（반복복수생장혹복수공제불이상）。C 조34례，치료과정중출현발열、복통、복기긴장，복막자격정양성，복수신속증장，이뇨제무효。분별관찰각조환자 PCT、CRP 급내독소적수평변화，복수배양적양성솔、내약솔급림상치료전귀솔。결과3조환자 PCT、CRP 급내독소수평검측，C 조여 A 조지간비교차이유통계학의의（P ＜0．05）。B 조동 C 조지간비교차이무통계학의의（P ＞0．05）。세균성복막염적발생분별위 A 조10례（26．32％），B 조25례（69．44％）급 C 조32례（94．12％）。복수배양적양성병원균위41주，39주내약。항감염치료후，67례세균성복막염호전36례（53．73％），치유15례（22．39％），사망16례（23．88％）。결론만가급성간쇠갈환자출현자발성세균성복막염적발병솔교고，조기발현가이공제병정，제고치유솔。
Objective To explore the early diagnosis and therapy of acute-on-chronic liver failure (ACLF)patients complicated with spontaneous bacterial peritonitis (SBP).Methods Serum calcitonin (PCT),C-reactive protein (CRP)and endotoxin were detected in all of 108acute-on-chronic liver failure patients complicated with or without SBP.For the former patients,ascites,conventional culture and drug sensitive test would be carried out.All patients were divided into three groups:group A (38 cases,patients with severe viral hepatitis,no indication of SBP),group B (36 cases,poor curative effect in patients with severe hepatitis treatment process which showed recurrent ascites growth or ascites poor controlled), and group C (34 cases,patients with fever,abdominal pain,abdominal muscle tension,positive peritoneal irritation,ascites rapid increased with diuretics therapy invalid in the process of treatment).Results PCT,CRP and endotoxin were detected.The difference between group A and group C was statistically significant (P <0.05 ),while difference between group B and group C showed no statistical significant (P >0.05 ).Ten cases of bacterial peritonitis incidence (10/38, 26.32%),25 cases (25/36,69.44%)and 32 cases (32/34,94.12%)were found in the three groups,respectively.Forty-one strains of positive pathogens were detected in the ascites cultivate patients,of which positive rate was 58.57% (41/70,).Furthermore,39 strains were drug-resistant bacteria (39/41 ,95.12%).After anti-infectious treatment,clinical symptoms were improved in 36 cases (36/67,53.73%),15 cases were cured (15/67,22.39%),while 16 cases died (16/67,23.88%).Conclusion Incidence of SBP in ACLF patients is higher,and early diagnosis and treatment could improve the prognosis.