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。
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 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.
【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 whether continuous quality improvement (CQI) measures can reduce the episodes of peritonitis. MethodsWe analyzed the data of 114 cases of peritoneal dialysis related peritonitis from January to December 2011 before applying CQI measures and 72 cases from January and December 2012 after applying CQI measures in West China Hospital. Then we studied the episodes, cause and pathogenic bacteria species of peritonitis in peritoneal dialysis patients. We implemented the process of reducing the episodes of peritonitis by applying PDCA four-step design: plan-do-check-act. ResultsThe episodes of peritonitis were reduced from per 60.8 patient-months (0.197/patient-years) to per 66.6 patient-months (0.180/patient-years) after applying CQI measures. The positive rate of pathogenic bacteria culture was both 50.0% before and after applying CQI measures, in which 66.7% were gram-positive cocci. The curing rate of peritonitis was increased from 57 case/times (76.3%) to 87 case/times (79.2%). Switching to hemodialysis rate was reduced from 17 cases/times (14.9%) to 10 cases/times (13.9%). Death cases was reduced from 9 cases/times (7.9%) to 5 cases/times (6.9%). ConclusionThese results show that the incidence of peritoneal dialysis related peritonitis decreases and the curing rate increases through CQI measures.
目的 探讨结核性腹膜炎（TBP）及癌性腹膜炎（CP）的螺旋CT表现，提高其诊断及鉴别诊断水平。 方法 回顾分析2009年9月－2010年9月经手术病理、穿刺活检或综合手段证实的22例TBP和45例CP患者的CT影像资料，采用χ2检验比较各种CT征象在两种病变中的发生率，结合病理、临床结果进行分析。 结果 TBP组及CP组患者大量腹水所占比例差异有统计学意义（36.4%、75.6%，χ2=9.703，P=0.002）；两组壁腹膜、肠系膜增厚构成比差异有统计学意义，TBP组以壁层腹膜均匀增厚、肠系膜污迹样改变为主，CP组壁层腹膜以结节、块样增厚为主；两组大网膜厚度差异有统计学意义。 结论 以壁层腹膜改变为基础，综合大网膜、肠系膜及腹水改变CT征象对两种病变的诊断及鉴别诊断具有重要意义。
Objective To investigate predictive value of procalcitonin (PCT) and C-reactive protein (CRP) levels for spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis ascites. Methods The clinical data of 140 patients with liver cirrhosis ascites treated in our hospital from January 2012 to January 2016 were retrospectively analyzed. According to the presence of SBP, these patients were divided into SBP group and non-SBP group. The clinical data were compared between these two groups. The receiver operating characteristic (ROC) curve was constructed to assess their sensitivities and specificities of PCT and CRP for diagnosis of SBP. Results The PCT and CRP levels of the SBP group were significantly higher than those of the non-SBP group (P<0.05). The differences of serum ALT, AST and white cell count between the SBP group and the non-SBP were not statistically significant (P>0.05). The ROC curve analysis showed that the area under the ROC curve of PCT and CRP were 0.895 and 0.926, their corresponding cut-off value 2.1 μg/L and 24.8 mg/L, the sensitivities were 86.9% and 89.5%, the specificities were 85.1% and 83.5%, respectively. Conclusion Abnormally elevated PCT and CRP levels might have an important detective value for SBP in patients with liver cirrhosis ascites.