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Management of spontaneous bacterial peritonitis in patients with liver cirrhosis
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摘要: 自发性细菌性腹膜炎(SBP)是肝硬化失代偿合并腹水患者的严重并发症,随着发生次数的增加,处理难度加大,患者的病死率提高。SBP的发生机制主要是肠黏膜防御功能低下和通透性增加,细菌通过肠粘膜易位至腹腔。腹水穿刺并多形核细胞计数仍然是诊断SBP最快捷、敏感和特异的手段。急性消化道大出血、腹水白蛋白低于10 g/L、发生过SBP等,是发生或再发SBP的高危因素。使用包括喹诺酮类在内的抗生素可有效预防SBP。治疗上应该从改善肝功能、处理肝脏原发病、补充白蛋白和合理使用抗生素等诸方面综合考虑。Abstract: Spontaneous bacterial peritonitis (SBP) is one of the serious complications in cirrhotic patients with ascites.The higher the incidence, the more difficult to treat and the higher the mortality rate.The mechanism of SBP is mainly decreased intestinal mucosal defense function and increased permeability, by which bacteria colonized in intestinal cavity translocate to the peritoneal cavity.Ascites puncture and polymorphonuclear cell count remains a rapid, sensitive and specific means of diagnosis for SBP.Acute gastrointestinal hemorrhage, ascites albumin below 10 g/L and previous SBP are high risk factors of recurrence of SBP.Application of antibiotics including quinolones can be effective in preventing SBP.Treatment should be comprehensively considered by improving liver function, treatment of original liver disease, albumin infusion and rational use of antibiotics.
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Key words:
- liver cirrhosis /
- peritonitis
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[1]Runyon BA;AASLD Practice Guidelines Committee.Man-agement of adult patients with ascites due to cirrhosis:anupdate[J].Hepatology, 2009, 49 (6) :2087-2107. [2]European Association for the Study of the Liver.EASL clinicalpractice guidelines on the management of ascites, spontane-ous bacterial peritonitis, and hepatorenal syndrome in cirrho-sis[J].J Hepatol, 2010, 53 (3) :397-417. [3] McGibbon A, Chen GI, Peltekian KM, et al. An evidence-based manual for abdominal paracentesis[J]. Dig Dis Sci, 2007, 52 (12) : 3307-3315. [4] Koulaouzidis A, Bhat S, Karagiannidis A, et al. Spontaneous bacterial peritonitis[J]. Postgrad Med J, 2007, 83: 379-383. [5]Terg R, Fassio E, Guevar M, et al.Ciprofloxacin in primaryprophylaxis of spontaneous bacterial peritonitis:A random-ized, placebo-controlled study[J].J Hepatol, 2008, 48 (5) :774-779. [6]Rena NM, Wibawa ID.Albumin infusion in liver cirrhotic pa-tients[J].Acta Med Indones-Indones J Intern Med, 2010, 42:162-168. [7]Kuiper JJ, De Man RA, Van Buuren HR.Review article:management of ascites and associated complications in pa-tients with cirrhosis[J].Aliment Pharmacol Ther, 2007, 26 (Suppl 2) :183-193. -
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