【摘要】 目的 探讨肝炎后肝硬化自发性细菌性腹膜炎（spontaneous bacterial peritonitis，SBP）的诊疗情况及头孢哌酮舒巴坦联合左旋氧氟沙星对SBP的治疗效果。 方法 对2004年1月-2009年12月收治的54例肝炎后肝硬化SBP患者，应用头孢哌酮舒巴坦联合左旋氧氟沙星给与治疗，并观察分析治疗效果。 结果 肝炎后肝硬化SBP的临床表现以发热，腹痛为主，具有典型腹膜刺激征的不足半数。外周血白细胞升高者不多见，腹腔积液中白细胞计数、PMN计数和细菌培养是自发性细菌性腹膜炎的重要诊断指标。 结论 肝炎后肝硬化合并SBP的临床表现不典型。致病菌以G-杆菌为主。在早期诊断、综合治疗的基础上，头孢哌酮舒巴坦联合左旋氧氟沙星对自发性细菌性腹膜炎的治疗效果显著。【Abstract】 Objective To evaluate the diagnosis and treatment of post-hepatitis cirrhosis complicated with spontaneous bacterial peritonitis (SBP) cases and the efficacy of cefoperazone and sulbactam combined with levofloxacin in the treatment of cirrhotic patients with SBP. Methods From January 2004 to December 2009, the clinical data from 54 cases of SBP after cirrhosis were analyzed. The patients underwent the treatment of cefoperazone sulbactam combined with levofloxacin. The therapeutic effect was observed. Results The main clinical manifestations were fever and abdominal pain, and about half of the patients had the typical peritoneal irritation. Only a few patients had elevated peripheral white blood cells (WBC). The WBC count, abdominal effusion polymorphonuclearcyte count and bacteria cultivation were the indexes of diagnosis of SBP. Conclusion The clinical features of post-hepatitis cirrhosis complicated with SBP are not typical. The main pathogenic bacteria is G- bacilli. In the early diagnosis and treatment, cefoperazone sulbactam combined with levofloxacin is effective.
ObjectiveTo investigate the diagnosis and treatment value of multi-disciplinary team (MDT) model in patient with gastric perforation combined with hyperthyroidism crisis.MethodWe summarized the experiences of MDT model in treating one case of gastric perforation with hyperthyroidism crisis in the Fuling Central Hospital of Chongqing City on February 2019.ResultsThis patient had a history of hyperthyroidism and didn’t receive systemic treatment, diagnosing as acute diffuse peritonitis and perforation of hollow organs. After MDT discussions and a series of treatments, including anti-infection, control of heart rate and hyperthyroidism, this patient underwent surgical treatment of gastric peptic ulcer perforation, during and after the surgery, this patient suffered from hyperthyroid crisis. The surgery was successful, with the operation time was about 110 min, and the blood loss was about 50 mL. There was no side injury occurred without blood transfusion, and the patient was cured and discharged on 20 days after operation. The patient was followed up for about 1 year, and the general condition and life returned to normal.ConclusionMDT discussion is a very helpful way in the treatment of gastric perforation combined with hyperthyroidism crisis and can give a better outcome.
目的:探讨腹膜透析相关性腹膜炎的治疗。方法:回顾性分析的89例腹膜透析相关性腹膜炎患者,初期使用头孢菌素和或氨基糖甙类抗生素治疗,严重者使用头孢唑林和头孢他啶治疗。结果:89例腹膜炎患者透析液培养阳性33例(37.1%),其中19例1～4d治愈(21.3%),56例4～14 d治愈(62.9%),复发11例(12.4%),2例因尿毒症而全身衰竭死亡(2.2%)。结论:虽然腹膜透析相关性腹膜炎的发病率有降低趋势,但其仍然是腹膜透析最常见并发症之一,我们在强调对腹膜炎治疗的同时,更要强调对腹膜炎的预防。
目的:观察莫西沙星治疗肝硬化并发原发性腹膜炎的疗效。方法:98例病例随机分成治疗组(51例)和对照组(47例),治疗组使用莫西沙星注射液400mg,静滴,1次 /天;对照组使用头孢哌酮/舒巴坦钠2g+左氧氟沙星注射液0.2g,静滴,2次/次,疗程7~10天。结果:治疗组总有效率为90.2%,明显高于对照组72.3%(Plt;0.05),并且能较快缓解患者感染的症状和体征,不良反应发生率仅为3.9%。结论:莫西沙星是治疗肝硬化并发原发性腹膜炎安全有效的药物
ObjectivesTo evaluate the clinical value of laparoscopic exploration in the diagnosis of tuberculous peritonitis by meta-analysis.MethodsThe Cochrane Library, PubMed, Web of Science, WanFang Data, CNKI and VIP databases were electronically searched to collect relevant studies on the diagnostic value of laparoscopic exploration in diagnosing tuberculous peritonitis from January 1st, 1990 to April 1st, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. The Rveman 5.3, Meta-DiSc 1.4 and Stata SE15 software were used for statistical analysis and the receiver operating characteristic curve (SROC) was drawn.ResultsA total of 10 studies involving 1098 patients were included. The results of meta-analysis showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio and area under the curve of SROC were 0.98 (95%CI 0.96 to 0.98), 0.85 (95%CI 0.78 to 0.91), 4.78 (95%CI 1.98 to 11.54), 0.06 (95%CI 0.03 to 0.12), 111.40 (95%CI 36.55 to 339.58) and 0.971 1, respectively and the Q* was 0.9216.ConclusionsThe existing evidence shows that laparoscopic exploration has higher sensitivity and specificity in the diagnosis of tuberculous peritonitis. Laparoscopic exploration can be used as a diagnosis and treatment tool for patients with tuberculous peritonitis in case the laboratory test cannot determine the origin. Due to the limited quality and quantity of included studies, the above results should be validated by more studies.
ObjectiveTo investigate the clinical characteristics, treatment and outcomes of patients with Acinetobacter baumannii peritoneal dialysis-related peritonitis.MethodsWe retrospectively analyzed the clinical data of patients with Acinetobacter baumannii peritoneal dialysis-related peritonitis in the First Affiliated Hospital of Airforce Military University from January 2011 to December 2018. The clinical baseline data, treatment process, microbiological data, antibiotic susceptibility test of the bacterial isolates and outcomes were analyzed.ResultsA total of 10 patients were enrolled, including 4 males and 6 females. The average age of all patients was (44.90±17.03) years, the average age of peritoneal dialysis was (21.70±17.06) months. Seven cases were infected for the first time, and 3 cases were reinfected. The infections were mainly caused by mechanical failure of catheter connection system (3 cases) or enterogenous infection (3 cases). The main symptoms were abdominal pain (10 cases), fever (7 cases) and diarrhea (3 cases). Empirical anti-infective treatment was given after admission, only 1 case was effective, and the treatment of the other 9 cases were adjusted according to the results of drug sensitivity. Acinetobacter baumannii was sensitive to cefoperazone, carbapenem (meropenem, imipenem), quinolones (ciprofloxacin, levofloxacin), aminoglycosides (gentamicin) and polymyxin. Only one case was resistant to ceftazidime. Among the 10 patients, 8 cases were cured (continued peritoneal dialysis), 1 case died, and 1 case dropped out from peritoneal dialysis to hemodialysis.ConclusionsAcinetobacter baumannii peritoneal dialysis-related peritonitis in this hospital is mainly caused by mechanical disturbance of catheter connection system or enterogenic infection. Appropriate measures, including aseptic standard operation, follow-up and effective anti-infective treatment, should be taken to decrease the incidence and mortality of Acinetobacter baumannii peritoneal dialysis-related peritonitis.
Objective To study the effect and intrinsic mechanism of acute suppurative peritonitis associated ascitic fluid (ASPAAF) on experimental liver injury of rats. Methods Thirty-two male or female Sprague-Dawley (SD) rats were randomly divided into two groups: ASPAAF group (n=16) and control group (n=16), in which 8 ml ASPAAF or normal saline (NS) were injected into the peritoneal cavity, respectively. The rats were killed at each time intervals after peritoneal cavity injection (6 h and 12 h) respectively in two groups and specimens were made to detect the levels of serum TNF-α, endotoxin and liver function (AST, ALT and STB). The level of TNF-α in liver tissues was measured. The pathological change of liver was observed by microscope. Results The levels of TNF-α, endotoxin, ALT, AST and STB in serum and the levels of TNF-α in liver tissues at different time points were markedly higher in ASPAAF group compared with those in control group (P＜0.05), and these indexes increased with increasing time in ASPAAF group (P＜0.05). In ASPAAF group, hepatic tissue appeared hydrops, even spotty necrosis and the changes at 6 h and 12 h were not obvious different. No abnormal pathological change of hepatic tissue was found in control group. Conclusion ASPAAF can induce the injury of the liver in rats, which may involved in TNF-α and endotoxin.
目的 分析持续腹膜透析患者发生腹膜炎的情况及相关因素，降低腹膜透析患者腹膜炎发生率、退出率，提高患者的生存率、生活质量。 方法 回顾分析2011年1月－6月收治的41例在家中行持续非卧床性腹膜透析且发生腹膜炎患者的临床资料，观察腹膜炎的发生率及转归，腹膜炎症状出现后初始的处理，对腹膜炎的诱因进行分析。 结果 41例腹膜透析患者共发生腹膜炎43例次，痊愈35例（85.4%），转血液透析3例（7.3%），死亡3例（7.3%）。在症状出现初期，3例（7.3%）患者继续在家观察，10例（24.4%）患者立即到当地就医，15例（36.6%）患者采用电话咨询，13例（31.7%）患者到腹膜透析中心就诊；18例（43.9%）患者直接将腹膜透析引流液带到医院进行药敏试验。就感染诱因而言，16例（39.0%）患者未严格进行空气消毒，13例（31.7%）患者未严格进行环境清洁，10例（24.4%）患者操作过程存在污染行为。 结论 加强对居家行腹膜透析患者的初次培训、操作指导及监测，可避免腹膜炎的发生，提高患者生活质量。