失代偿期肝硬化腹水合并自发性腹膜炎患者的临床观察

发布时间：2018-06-04 08:46

本文选题：失代偿期肝硬化腹水 + 自发性腹膜炎　；参考：《中华医院感染学杂志》2015年14期

【摘要】：目的了解失代偿期肝硬化腹水合并自发性腹膜炎患者的临床特点,为该疾病的治疗提供研究数据。方法对147例失代偿期肝硬化腹水合并自发性腹膜炎患者的腹水标本进行病原菌检测和药敏试验,并检测产超广谱β-内酰胺酶(ESBLs)菌株,治疗后评价治疗效果;采用SPSS20软件进行统计分析。结果从腹水标本中共检出病原菌161株,其中革兰阴性菌114株占70.81%,以大肠埃希菌、肺炎克雷伯菌为主,革兰阳性菌33株占20.49%,以表皮葡萄球菌、粪肠球菌为主,真菌14株占8.70%,以白色假丝酵母菌为主;大肠埃希菌对美罗培南、亚胺培南的耐药率均为0,产ESBLs大肠埃希菌对常见抗菌药物的耐药率高于非产ESBLs大肠埃希菌;治疗后,显效41例、好转51例、无效55例,治疗总有效率为62.59%。结论自发性腹膜炎的临床表现不明显,进展快、预后差、病死率高,其主要病原菌为革兰阴性菌,对于失代偿期肝硬化腹水合并自发性腹膜炎的治疗,应进行腹水标本的采集和病原菌药敏试验,合理选用敏感抗菌药物,有利于获得满意的治疗效果。
[Abstract]:Objective to investigate the clinical characteristics of patients with decompensated cirrhosis and ascites associated with spontaneous peritonitis and to provide data for the treatment of the disease. Methods pathogenic bacteria and drug sensitivity tests were performed in 147 ascites samples from patients with decompensated cirrhosis and ascites associated with spontaneous peritonitis. Extended-spectrum 尾 -lactamases (ESBLs) strains were detected and the therapeutic effects were evaluated after treatment. SPSS20 software was used for statistical analysis. Results A total of 161 strains of pathogenic bacteria were detected from ascites, of which 114 were Gram-negative bacteria (70.81%), mainly Escherichia coli, Klebsiella pneumoniae, 33 Gram-positive bacteria (20.49), and Staphylococcus epidermidis and Enterococcus faecalis. The resistance rate of Escherichia coli to meropenem and imipenem was 0, the resistance rate of ESBLs producing Escherichia coli to common antibiotics was higher than that of non-producing ESBLs Escherichia coli. 51 cases were improved, 55 cases were ineffective, the total effective rate was 62.59%. Conclusion the clinical manifestation of spontaneous peritonitis is not obvious, the progress is fast, the prognosis is poor, the mortality is high, the main pathogenic bacteria is Gram-negative bacteria, for the treatment of decompensated cirrhosis ascites with spontaneous peritonitis. The collection of ascites and the drug sensitivity test of pathogenic bacteria should be carried out, and the rational selection of sensitive antimicrobial agents is beneficial to the satisfactory therapeutic effect.
【作者单位】：温州医科大学附属舟山医院感染性疾病科;浙江大学医学院附属第一医院感染性疾病科;
【基金】：国家自然科学基金资助项目(81371859)
【分类号】：R575.2

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