哌拉西林舒巴坦治療肝硬化患者自發性細菌性腹膜炎的臨床觀察

吳瑩雯 張桂靈 姜宏偉 章燕燕 陳龍達 李娜

[摘要] 目的 觀察哌拉西林舒巴坦治療乙型肝炎肝硬化合并自發性細菌炎腹膜炎（SBP）的臨床療效。 方法 收集分析2015年12月～2017年12月60例肝硬化患者，并用隨機數字表分為兩組，在護肝、利尿及支持療法的基礎治療上，對照組采用頭孢曲松治療，治療組采用哌拉西林舒巴坦治療，對兩組治療第3天、第7天時進行療效評估，同時治療過程中癥狀體征及實驗室指標加重的患者調整其他方案進行。 結果 兩組治療3 d、7 d臨床總有效率、CRP、PCT、IL-6及TNF-α炎性因子均較治療前有明顯差異（P<0.05）。治療3 d，治療組在臨床總有效率、PCT、IL-6及TNF-α較對照組差異有統計學意義（P<0.05），在CRP表達上差異無統計學意義（P=0.267>0.05）。治療7 d后，治療組中臨床總有效率、炎性因子均較對照組有明顯差異（P<0.05）。 結論 哌拉西林舒巴坦治療SBP患者炎性因子的分泌有抑制作用，可以有效地控制自發性細菌性腹膜炎患者的細菌感染。在高耐藥背景下，針對自發性細菌炎腹膜炎治療選擇哌拉西林舒巴坦具有高價值。

[關鍵詞] 肝硬化;自發性細菌性腹膜炎;抗生素;哌拉西林舒巴坦

[中圖分類號] R512.6? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 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.