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yxfbbiedtj · Wysłany: Pią 8:59, 18 Mar 2011

Severe hepatitis complicated with spontaneous bacterial peritonitis 44 cases

And septic shock in 3 cases (6.8%). Improvement in the older group accounted for 1 case of cure, mortality accounted for the old age group (85.7%). 4 discuss the causes of severe hepatitis and SBP may be associated with body weight in patients with a variety of defense mechanisms of liver damage, liver detoxification function decline, bowel dysfunction, intestinal flora, pathogenic bacteria overgrowth, intestinal bacteria invade the bloodstream and then infected peritoneal about: the same time, many patients because of severe hepatitis associated with ascites and ascites has also become a good medium for bacterial growth. The data of patients with fever in 70.5%, 88.6% of patients had abdominal distension, suggesting that fever, abdominal distension is the most common clinical symptoms of SBP. Patients without abdominal pain, 65.9%, 38.6% of patients without abdominal tenderness, peritoneal irritation symptoms often atypical or absent, which may be 86.3% of patients with ascites diluted related inflammatory substances. Therefore, patients should be promptly suspected routine examination for ascites, and when the diagnosis and treatment. In general,[link widoczny dla zalogowanych], routine examination of ascites is an important means of diagnosis and treatment of SBP. Ascites WBC> 500X109L, PMN> 50% can be diagnosed as SBP; WBC> 300X10. / L,[link widoczny dla zalogowanych], PMN> 50%, with clinical manifestations can be diagnosed as SBP. However, often accompanied by severe hepatitis patients with low protein ascites, complicated with SBP, its exudate was diluted by leakage of fluid, ascites white blood cell count often not reach the standard effusion (> 500X10 ~ L), ascites volume of more large, inflammatory cells diluted, WBC may be more. Less. This information is only 36.4% of patients in ascites WBC> 500X106 / L, but ascites is relatively constant ratio of multi-core white blood cells, and this article, severe hepatitis patients complicated with SBP in ascites PMN> 50% accounted for 88.7%, suggesting diagnosis of ascites PMN is the more reliable indicators of SBP. The data also showed that 27.3% of the total number of WBC in peripheral blood is not high, but 88.6% of patients with GR> 70%. This may be related to SBP, the main pathogen of intestinal bacteria on G. Therefore, if the weight ratio of hepatic GR in peripheral blood increased, pay attention to the possibility of infection. · L7 · Zhaoqing Medicine 1, 2006 (total 56) ascites of confirmed bacterial culture is the basis of SBP, but the low rate of positive culture of ascites limit its application in the diagnosis of SBP value. The data rate of ascites culture was positive in 13.6%. Another of the information ascites bacterial culture and sensitivity results indicate that SBP in the more common types of bacteria to intestinal bacteria, this paper 6 cases of positive bacterial culture of E. coli in 4 cases,[link widoczny dla zalogowanych], 1 case of type Enterococcus, Klebsiella pneumoniae, 1 case to Escherichia coli bacteria, and the third-generation cephalosporins effective against imipenem sensitive. However, the clinical drug selection should take into account the G and G-bacterial drugs. If antibiotic therapy is poor,[link widoczny dla zalogowanych], continuing down the body temperature should be thought of the possibility of fungal infection. The data also show that severe hepatitis patients with SBP can significantly increase the patient's condition and high mortality (81.8%), even more elderly patients (85.7%), the leading cause of death is still the primary liver disease complications, followed by hepatorenal syndrome, hepatic encephalopathy, upper gastrointestinal bleeding, septic shock. Therefore,[link widoczny dla zalogowanych], the treatment of this disease in the Liver support, active treatment of complications in vital organs to improve the same time, rational use of antimicrobial drugs in a timely manner is critical. But the widespread use of antibiotics significantly increased the drug-resistant, multi-drug resistance and double infection occurred, causing difficulties to the treatment. Therefore, patients with severe hepatitis clinicians should be highly alert and appropriate relaxation of the indications for diagnostic paracentesis and ascites culture methods to improve early diagnosis of SBP is an effective measure. Once the diagnosis of SBP clear, sensitive to antimicrobial agents should be promptly used to increase the survival rate. At the same time to lose fresh plasma or albumin therapy to improve efficacy.