目的:探討腹膜透析相關性腹膜炎的治療。方法:回顧性分析的89例腹膜透析相關性腹膜炎患者,初期使用頭孢菌素和或氨基糖甙類抗生素治療,嚴重者使用頭孢唑林和頭孢他啶治療。結果:89例腹膜炎患者透析液培養陽性33例(37.1%),其中19例1～4d治愈(21.3%),56例4～14 d治愈(62.9%),復發11例(12.4%),2例因尿毒癥而全身衰竭死亡(2.2%)。結論:雖然腹膜透析相關性腹膜炎的發病率有降低趨勢,但其仍然是腹膜透析最常見并發癥之一,我們在強調對腹膜炎治療的同時,更要強調對腹膜炎的預防。
Objective To study the effects of different carbon dioxide pneumoperitoneum pressure and time on abdominal cavity infection bacteria of peritonitis in rats, including bacteria growth and bacterial translocation. Methods Sixty Sprague Dawley rats were injected with Eseherichia coli into the abdominal cavity to establish models of intra-abdominal infection. To give 3 types of pneumoperitoneum pressure for the experimental group: 15 mm Hg (1 mm Hg=0.133 kPa) for high pressure group, 5 mm Hg for low pressure group, and blank control group for no-pneumoperitoneum. To give 2 types of experimental period: 1 h and 3 h. These 60 Sprague Dawley rats were randomly divided intomoperi 6 groups by random number table. They were treated by different pneumoperitoneum pressure and time. All rats were killed at the end of the carbon-dioxide pneumo-peritoneum experiment. Peritoneal lavage fluids and portal vein blood were taken for microbiological examinations and culture. The endotoxin content in portal vein blood was detected too. Results ① Bacteria content: bacteria counts of different pneumoperitoneum pressure groups were obviously different (F=9.02, P=0.020), bacteria counts of different experimental period groups were obviously different (F=8.47, P=0.003), the effect of time was different in different pneumoperitoneum pressure groups (F=8.07, P=0.020). ② Bacterial translocation: Bacterial translocation occurred in all 6 groups. Blood culture positive rates were similar between 1 h group and 3 h group at 3 types of pneumoperitoneum pressure groups (P>0.05). The positive rate of blood culture in high pneumoperitoneum group was significantly higher compared with the no-pneumoperitoneum group (P<0.05). ③ The endotoxin content: the endotoxin content of different pneumoperitoneum pressure groups were obviously different (F=14.70, P<0.01), the endotoxin content in plasma increased obviously in high pressure group compared with low pressure group (P=0.018) and no-pneumoperitoneum group (P<0.01), the endotoxin content in plasma increased obviously in low pressure group compared with no-pneumoperitoneum group (P=0.005). The endotoxin content of different experimental period groups were obviously different (F=148.90, P<0.01), the endotoxin content in plasma increased obviously in 3 h group compared with 1 h group. There were no significant difference in the effect of time with different pneumoperitoneum pressure groups (F=0.14, P=0.874). Conclusion CO2pneumoperitoneum promoted intestinal bacterial endotoxin and bacterial translocation in peritonitis of rats, which increased with the pressure and time.
【摘要】 目的 探討肝炎后肝硬化自發性細菌性腹膜炎（spontaneous bacterial peritonitis，SBP）的診療情況及頭孢哌酮舒巴坦聯合左旋氧氟沙星對SBP的治療效果。 方法 對2004年1月-2009年12月收治的54例肝炎后肝硬化SBP患者，應用頭孢哌酮舒巴坦聯合左旋氧氟沙星給與治療，并觀察分析治療效果。 結果 肝炎后肝硬化SBP的臨床表現以發熱，腹痛為主，具有典型腹膜刺激征的不足半數。外周血白細胞升高者不多見，腹腔積液中白細胞計數、PMN計數和細菌培養是自發性細菌性腹膜炎的重要診斷指標。 結論 肝炎后肝硬化合并SBP的臨床表現不典型。致病菌以G-桿菌為主。在早期診斷、綜合治療的基礎上，頭孢哌酮舒巴坦聯合左旋氧氟沙星對自發性細菌性腹膜炎的治療效果顯著。【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 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.
ObjectiveTo investigate the clinical characteristics, treatment and outcomes of patients with Acinetobacter baumannii peritoneal dialysis-related peritonitis.MethodsWe retrospectively analyzed the clinical data of patients with Acinetobacter baumannii peritoneal dialysis-related peritonitis in the First Affiliated Hospital of Airforce Military University from January 2011 to December 2018. The clinical baseline data, treatment process, microbiological data, antibiotic susceptibility test of the bacterial isolates and outcomes were analyzed.ResultsA total of 10 patients were enrolled, including 4 males and 6 females. The average age of all patients was (44.90±17.03) years, the average age of peritoneal dialysis was (21.70±17.06) months. Seven cases were infected for the first time, and 3 cases were reinfected. The infections were mainly caused by mechanical failure of catheter connection system (3 cases) or enterogenous infection (3 cases). The main symptoms were abdominal pain (10 cases), fever (7 cases) and diarrhea (3 cases). Empirical anti-infective treatment was given after admission, only 1 case was effective, and the treatment of the other 9 cases were adjusted according to the results of drug sensitivity. Acinetobacter baumannii was sensitive to cefoperazone, carbapenem (meropenem, imipenem), quinolones (ciprofloxacin, levofloxacin), aminoglycosides (gentamicin) and polymyxin. Only one case was resistant to ceftazidime. Among the 10 patients, 8 cases were cured (continued peritoneal dialysis), 1 case died, and 1 case dropped out from peritoneal dialysis to hemodialysis.ConclusionsAcinetobacter baumannii peritoneal dialysis-related peritonitis in this hospital is mainly caused by mechanical disturbance of catheter connection system or enterogenic infection. Appropriate measures, including aseptic standard operation, follow-up and effective anti-infective treatment, should be taken to decrease the incidence and mortality of Acinetobacter baumannii peritoneal dialysis-related peritonitis.
目的:觀察莫西沙星治療肝硬化并發原發性腹膜炎的療效。方法:98例病例隨機分成治療組(51例)和對照組(47例),治療組使用莫西沙星注射液400mg,靜滴,1次 /天;對照組使用頭孢哌酮/舒巴坦鈉2g+左氧氟沙星注射液0.2g,靜滴,2次/次,療程7~10天。結果:治療組總有效率為90.2%,明顯高于對照組72.3%(Plt;0.05),并且能較快緩解患者感染的癥狀和體征,不良反應發生率僅為3.9%。結論:莫西沙星是治療肝硬化并發原發性腹膜炎安全有效的藥物
Objective To investigate the pathogenesis of acute lung injury in rats induced by intra-peritoneally injection of perforative peritonitis ascitic fluids（PPAF） and the role of L-arginine （L-Arg） in acute lung injury in this model. Methods Perforative peritonitis （PP） models were established in 60 rats and PPAF were collected. Forty-eight rats were randomly divided equally into NS group，PPAF group, and L-Arg group. Rats were randomly subjected to death at 7 h and 12 h. Peripheral blood WBC were counted，levels of NO and malondialdehyde （MDA） in serum were examined. Lung injury score and wet/dry ratio were evaluated， and level of myeloperoxidase （MPO） in lung tissues and lung cell apoptosis were tested. Results WBC count of peripheral blood, levels of NO and MDA in serum， level of MPO in lung tissue, lung injury score， wet/dry ratio， and lung cell apoptosis rate in PPAF group were significantly higher than that in NS group at each time point（P＜0.01）. Level of NO in serum in L-Arg group was higher than that in PPAF group （P＜0.01）， but lower level of MDA in serum， lower level of MPO in lung tissue and lung injury score，lower wet/dry ratio， and lung cell apoptosis rate were observed in L-Arg group（P＜0.05）. In PPAF group and L-Arg group， level of NO in serum， wet/dry ratio, and lung cell apoptosis rate were higher at 12 h than that at 7 h（P=0.000）. Serum NO level was in negative correlation with serum MDA level （r=-0.257，P=0.021）， MPO level in lung tissue（r=-0.444， P=0.011），and lung cell apoptosis（r=-0.351， P =0.010） in PPAF group and L-Arg group， but serum MDA level was in positive correlation with cell apoptosis（r=0.969， P＜0.001） in each group. Conclusions Acute lung injury rats model can be established by intra-peritoneally injection of PPAF. Enhanced oxidizing reaction and cell apoptosis take part in the occurrence of acute lung injury. L-Arg plays a protective role in acute lung injury.