哌拉西林舒巴坦治疗肝硬化患者自发性细菌性腹膜炎的临床观察

吴莹雯 张桂灵 姜宏伟 章燕燕 陈龙达 李娜

[摘要] 目的 觀察哌拉西林舒巴坦治疗乙型肝炎肝硬化合并自发性细菌炎腹膜炎（SBP）的临床疗效。 方法 收集分析2015年12月～2017年12月60例肝硬化患者，并用随机数字表分为两组，在护肝、利尿及支持疗法的基础治疗上，对照组采用头孢曲松治疗，治疗组采用哌拉西林舒巴坦治疗，对两组治疗第3天、第7天时进行疗效评估，同时治疗过程中症状体征及实验室指标加重的患者调整其他方案进行。 结果 两组治疗3 d、7 d临床总有效率、CRP、PCT、IL-6及TNF-α炎性因子均较治疗前有明显差异（P<0.05）。治疗3 d，治疗组在临床总有效率、PCT、IL-6及TNF-α较对照组差异有统计学意义（P<0.05），在CRP表达上差异无统计学意义（P=0.267>0.05）。治疗7 d后，治疗组中临床总有效率、炎性因子均较对照组有明显差异（P<0.05）。 结论 哌拉西林舒巴坦治疗SBP患者炎性因子的分泌有抑制作用，可以有效地控制自发性细菌性腹膜炎患者的细菌感染。在高耐药背景下，针对自发性细菌炎腹膜炎治疗选择哌拉西林舒巴坦具有高价值。

[关键词] 肝硬化;自发性细菌性腹膜炎;抗生素;哌拉西林舒巴坦

[中图分类号] R512.6          [文献标识码] A          [文章编号] 1673-9701（2019）21-0024-04

Clinical observation of piperacillin-sulbactam in the treatment of spontaneous bacterial peritonitis in patients with liver cirrhosis

WU Yingwen ZHANG Guiling JIANG Hongwei ZHANG Yanyan CHEN Longda LI Na

Department of Infectious Diseases， Yuyao People's Hospital in Zhejiang Province， Yuyao   315400， China

[Abstract] Objective To observe the clinical efficacy of piperacillin-sulbactam in the treatment of hepatitis B cirrhosis combined with spontaneous bacterial peritonitis（SBP）. Methods 60 patients with liver cirrhosis from December 2015 to December 2017 were collected and analyzed. And the patients were divided into two groups. Based on the basic treatment including liver protection， diuresis and supportive therapy， the control group was treated with ceftriaxone， and the treatment group was treated with piperacillin-sulbactam. The efficacy of the two groups on the 3rd and 7th day of treatment was evaluated. And other options were adjusted for patients with aggravated symptoms and signs and laboratory indicators during the treatment. Results The total effective rate， CRP， PCT， IL-6 and TNF-α inflammatory factors in the two groups after 3 days and 7 days of treatment were significantly different from those before treatment（P<0.05）. After 3 days of treatment， the clinical total effective rate， PCT， IL-6 and TNF-α in the treatment group were statistically significant compared with those of the control group（P<0.05）， and there was no statistical significance in the expression of CRP （P=0.267>0.05）. After 7 days of treatment， the total clinical effective rate and inflammatory factors in the treatment group were significantly different from those in the control group（P<0.05）. Conclusion Piperacillin-sulbactam can inhibit the secretion of inflammatory factors in patients with SBP and can effectively control bacterial infection in patients with spontaneous bacterial peritonitis. In the context of high drug resistance， the choice of piperacillin-sulbactam for the treatment of spontaneous bacterial peritonitis is of high value.