目的 探究血必净注射液联合亚胺培南治疗肝硬化并发自发性细菌性腹膜炎的临床疗效。方法 选取2013年8月—2015年8月黄河三门峡医院消化内科收治的肝硬化并发自发性细菌性腹膜炎患者88例,随机分为对照组和治疗组,每组各44例。对照组患者腹腔穿刺放液≤2 000 mL/d,放液后给予注射用亚胺培南西司他丁钠0.5 g/次,1次/d,同时静脉滴注注射用亚胺培南西司他丁钠,0.5 g加入到0.9%生理盐水100 mL中,3次/d。治疗组在对照组治疗基础上静脉滴注血必净注射液,50 mL加入到0.9%生理盐水100 mL中,1次/d。两组均连续治疗7 d。观察两组的临床疗效,比较两组发热、腹胀、腹痛、腹部压痛和反跳痛等临床症状消失时间。观察两组并发症的发生率,同时比较两组治疗前后白细胞(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)的变化。结果 治疗后,对照组和治疗组的总有效率分别为75.00%、90.91%,两组比较差异有统计学意义(P<0.05)。治疗组发热、腹胀、腹痛、腹部压痛和反跳痛等临床症状消失时间均显著短于对照组,两组比较差异具有统计学意义(P<0.05)。两组WBC、CRP、PCT、TNF-α、IL-6均较治疗前显著降低,同组治疗前后差异具有统计学意义(P<0.05);且治疗7 d后治疗组这些观察指标显著低于对照组,两组比较差异具有统计学意义(P<0.05)。对照组和治疗并发症的总发生率分别为18.18%、4.55%,两组比较差异具有统计学意义(P<0.05)。结论 血必净注射液联合亚胺培南治疗肝硬化并发自发性细菌性腹膜炎的临床疗效显著,可以显著缓解临床症状,降低并发症的发生率,还可以降低血清炎症因子的表达,具有一定的临床推广应用价值。

Objective To explore clinical efficacy of Xuebijing Injection combined with imipenem in treatment of liver cirrhosis complicated with spontaneous bacterial peritonitis. Methods Patients (88 cases) with liver cirrhosis complicated with spontaneous bacterial peritonitis in Huanghe Sanmenxia Hospital from August 2013 to August 2015 were randomly divided into control and treatment groups, and each group had 44 cases. The patients in the control group were administered with abdominal puncture, and drainage was less than or equal to 2000 mL/d, and they were given Imipenem and Cilastatin Sodium for injection 0.5 g/time after liquid discharge, once daily. The patients in the control group were iv administered with Imipenem and Cilastatin Sodium for injection, 0.5 g added into 0.9% normal saline 100 mL, three times daily. The patients in the treatment group were iv administered with Xuebijing Injection, 50 mL added into 0.9% normal saline 100 mL, once daily. The patients in two groups were treated for 7 d. After treatment, the efficacy was evaluated, and disappeared time of clinical symptoms such as fever, abdominal distension, abdominal pain, abdominal tenderness, and back pain in two groups were compared. The incidence of complications in two groups was observed, and the changes of WBC, CRP, PCT, TNF-α, and IL-6 in two groups were compared. Results After treatment, the efficacies in the control and treatment groups were 75.00% and 90.91%, respectively, and there were differences between two groups (P < 0.05). Disappeared times of clinical symptoms such as fever, abdominal distension, abdominal pain, abdominal tenderness and back pain in two groups were shorter than those in control group, with significant difference between two groups (P < 0.05). WBC, CRP, PCT, TNF-α, and IL-6 were significantly reduced, and the difference was statistically significant in the same group (P < 0.05). After treatment for 7 d, the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). The incidence of complications in the control and the treatment groups were 18.18% and 4.55%, with significant difference between two groups (P < 0.05). Conclusion Xuebijing Injection combined with imipenem has clinical curative effect in treatment of liver cirrhosis complicated with spontaneous bacterial peritonitis, and can significantly relieve the clinical symptoms, also can reduce the incidence of complications, while can reduce the expression of serum inflammatory cytokines, which has a certain clinical application value.