老年腹透患者应用双联系统预防腹膜炎的临床效应

目的　探讨应用新的腹膜透析管连接系统装置 (双联系统 )减少老年腹透患者腹膜炎发生率的作用。方法　通过对两种腹膜透析装置 (O型管组 ,双联系统组 )应用于老年腹透患者 ,对比观察腹膜炎发生率。结果　 O型管组腹膜炎发生率为 1次 / 1 4 .6病人月 (0 .82次 /病人年 ) ,双联系统组腹膜炎发生率为 1次 / 95.2病人月 (0 .1 3次 /病人年 ) (P<0 .0 5)。结论　双联系统能显著减少老年腹膜透析患者腹膜炎的发生     

腹膜清除特性在CAPD并腹膜炎改变的临床探讨

对30例CRF和ARF病人行不卧床持续性腹膜透析(CAPD)治疗,其中并腹膜炎20例次,其发生率由1983年前1次/5.87病人月降至1983年后1次/14.20病人月。并对15例腹膜炎者进行了腹膜对溶质清除特性、蛋白丢失量、葡萄糖吸收量和水的超滤量(出入超量)等方面的探讨。     

二级医院腹膜透析相关性腹膜炎诱发因素的回顾性分析

目的 探讨终末期肾脏病持续不卧床腹膜透析(CAPD)患者透析相关性腹膜炎的诱发因素,提高腹膜透析相关性腹膜炎的防治水平.方法 回顾性分析我院2010年1月～2012年12月内收集的139例腹膜透析患者的临床资料,对其中腹膜炎患者的诱发因素进行分析;比较原发病、营养状况、家居环境、腹膜透析操作、文化程度等因素与腹膜炎发生的关系.结果 139例患者中,42例发生腹膜炎71例次,发生率为1次/24患者月.致病菌中革兰阳性菌多见(71.7％).操作不规范(45.1％)、感染性疾病(38.0％)、便秘(9.8％)是引发腹膜炎的主要因素.原发糖尿病、营养状况、家居环境、文化水平与腹膜炎的发生有关(P＜0.05).结论 腹膜透析相关性腹膜炎多与操作不规范、感染性疾病以及便秘有关.原发病为糖尿病、营养不良、家居环境差、文化水平低的患者更易发生腹膜炎.     

腹膜透析相关腹膜炎危险因素分析

目的 研究腹膜透析患者腹膜炎发生危险因素,以此定位高危人群,为临床个体化干预治疗提供指导.方法 收集单中心维持性腹膜透析患者266例,以是否发生腹膜炎分为腹膜炎组和对照组.采用单因素和Logistic回归分析腹膜透析相关腹膜炎发生的操作及非操作危险因素,ROC曲线确定其最佳预测值.结果 腹膜炎组总体文化程度、透析龄显著低于对照组;而体质量指数、腹膜透析操作总误评分显著高于对照组.腹膜炎组在随访时血红蛋白及血浆白蛋白显著低于对照组,时间平均血浆白蛋白亦显著低于对照组.Logistic回归分析显示,随访血浆白蛋白＜28.95g/L、随访前白蛋白＜280.95 mg/L、时间平均血浆白蛋白＜29.78 g,/L、透析龄＜14.50个月,以及腹膜透析操作总误评分≥19.50分为腹膜透析相关腹膜炎发生的危险因素.结论 低白蛋白血症、较短透析龄,以及腹膜透析操作错误为腹膜透析相关腹膜炎发生的危险因素.临床可针对相关高危人群进行个体化干预,从而降低腹膜透析相关腹膜炎发生率,改善患者生活质量和预后.     

系统性护理干预对腹膜透析患者腹膜炎发生率的影响

目的探讨系统性护理干预对腹膜透析患者腹膜炎发生率的影响。方法选择我院收治的腹膜透析患者148例,采用随机数字表法分为观察组(75例)和对照组(73例)。对照组患者给予常规护理,观察组患者在对照组护理的基础上给予系统性护理干预。干预15个月后,比较两组患者的腹膜炎发生率及患者对护理服务的满意度。结果对照组73例患者中发生腹膜炎35例(47. 95%),观察组75例患者中发生腹膜炎16例(21. 33%),观察组患者的腹膜炎发生率显著低于对照组,差异有统计学意义(P 0. 05);观察组患者对护理服务的满意度(94. 67%)显著高于对照组(80. 82%),差异有统计学意义(P 0. 05)。结论系统性护理干预可显著降低腹膜透析患者的腹膜炎发生率,提高患者对护理服务的满意度,值得在临床推广应用。     

“O”set腹透对患者生活质量的影响

本文比较了不同连接方式对连续不卧床腹膜透析患者生活质量和腹膜炎发生率的影响。３４例用单接头连接方式进行透析，４７例用Ｏ型管道进行透析，采用生活质量用表由患者回答，并统计了腹膜炎发生率，结果显示Ａ组的生活质量明显低于Ｂ组，而腹膜炎发生率则高于Ｂ组，提示用Ｏ型管组进行腹透能明显提高患者生活质量。     

老年人持续非卧床腹膜透析的10年经验

1979～1989年间,作者对37例老年肾衰患者施行腹膜透析。腹膜内插管均在手术室于局麻或全麻下进行,关闭切口前,使用X线调整好导管位置,术后由有经验的透析护士观察1～3个月。腹膜透析导管诱发腹膜炎的诊断标准是(1)腹痛和压痛;(2)腹膜炎无其它原因;(3)腹膜内渗出液中白细胞升高(7100/mm~3);(4)腹膜内分泌液中有细菌生长。全部导管诱发腹膜炎者均住院治疗,接受静脉内或腹膜内抗生素治疗,若48小时症状仍无改善,则拔出导管或/和剖腹探查。 37例持续非卧床腹膜透析(CAPD)患者,平均年龄65.1岁,男性25例,女性12例,平均随访3.5±2.1年。31例患者共发生腹膜炎61例次,每人每年发生率为1.41次。插入导管到首次发生腹膜炎的平均时间为1.8年,最常见的致病菌为表皮葡萄     

腹腔内分别二次灌注万古霉素治疗CAPD革兰阳性细菌性腹膜炎

腹膜炎仍然是连续性不卧床性腹膜透析(CAPD)的主要并发症。美国最近报告,其发生率为1.5次/人·年。CAPD 治疗的头12个月内约70%的患者至少发生1次腹膜炎。治疗革兰阳性菌腹膜炎的传统方法是在每袋透析液中加入抗生素,但这不仅费时、花钱,且     

西藏地区腹膜透析患者现状调查

目的:分析西藏地区腹膜透析患者现状,为提高腹膜透析质量提供依据。方法:回顾性分析2011年5月至2016年6月在西藏自治区人民医院接受腹膜透析治疗的患者的临床及实验室资料,用单因素COX回归分析腹膜炎及死亡事件的相关因素。结果:56例腹膜透析患者,导致终末期肾病的首要病因是肾小球肾炎(43例,76.8%)、其次为糖尿病肾病(4例,7.1%)。腹膜炎的发病率为1/35.8患者月,是导致技术失败的首要原因。第1、2、3年的患者生存率分别为95.8%、83.5%、79.9%,主要死亡原因是肺部感染和心功能不全。C反应蛋白与死亡风险增加显著相关(HR 1.03,95%CI 1.01~1.05,P=0.004)。结论:西藏地区腹膜透析患者进入终末期肾病的首要病因是肾小球肾炎。本组患者腹膜炎发生率偏高,导致死亡的主要原因是肺部感染和心功能不全。C反应蛋白升高是死亡的危险因素。     

终末期肾衰患者脂代谢紊乱及相关因素分析

终末期肾脏病 (ESRD)患者常伴有脂质代谢紊乱[1] 。本文通过分析肾脏替代治疗对脂质代谢的影响和原因 ,探讨ESRD患者脂质代谢紊乱的临床特点、发生原因和相关因素。1　对象和方法1.1　对象　ESRD患者共 94例 ,平均年龄 5 4 2± 11 9岁。分为三组 :非透析 (CRF)组 (n =2 3)。血清肌酐 (SCr) >4 4 5μmol/L ,稳定 6个月以上。腹膜透析 (PD)组 (n =2 6 ) ,均采用Baxter公司Dianeal PD 2腹膜透析液 ,进行连续性非卧床腹膜透析 (CAPD)。血液透析 (HD)组 (n =4 5 )。以上患者均无糖尿病、高血压肾硬化、肝功能异常、家族性高脂血症、…     

Own modification of the visualization of adhesions in the peritoneal cavity in patients treated with continuous ambulatory peritoneal dialysis

The intraperitoneal adhesions were imagined with 3 non-invasive methods such as scintigraphy, ultrasonography, computerised tomography in 25 patients (pts) on CAPD (13 females and 12 males, aged 8-72 years). Initial imaging of peritoneal cavity was performed up to 4 months after the start of CAPD and repeated every 6-12 months of further therapy. In 9 patients the adhesions where detected at the start of CAPD. Only in 4 the progression of adhesions was diagnosed as a change of the structure from single to multiple or multilocular. In all these pts, peritonitis occurred at least once in the course of CAPD. Loss of ultrafiltration resulted in transfer from CAPD to HD. In others 5 pts the consecutive images of peritoneum were stable. In 16 remaining pts the adhesions were detected in the course of CAPD programme, in 6 of these pts after peritonitis and in other 10 without known causes. In 4 pts the progression of adhesions to multiple or multilocular was detected during next 2-3 years of CAPD programme. Two of these pts had to be transferred to HD. In 12 pts the images of adhesions were stable. Together, 6 pts (24%) had to be transferred to HD, because of the progression of intraperitoneal adhesions in the course of further CAPD. In conclusion, own modification of imaging of peritoneal adhesions let us not only to estimate the influence of this complication on the intraperitoneal dialysate distribution, but also enables non-invasive monitoring of CAPD programme.     

醋酸钙联合低钙透析液在老年高钙高磷腹膜透析患者中的应用

目的 探讨醋酸钙联合低钙透析液治疗对并发高钙和高磷血症老年腹膜透析患者钙磷代谢状况的影响.方法 选择行CAPD治疗6m以上、病情稳定且伴有高钙、高磷血症的老年患者20例,随机分为对照组（使用含钙1.5 mmol/L透析液＋饮食控制）和治疗组（使用含钙1.25 mmol/L透析液＋醋酸钙＋饮食控制）,每组10例,分别观察治疗前、治疗后1、3和6个月的血钙、血磷、钙磷乘积、iPTH和相关不良反应.结果 ①共18人完成该临床研究,其中对照组有1人因出现腹透相关性腹膜炎退出研究;试验组有1人因无法耐受服用醋酸钙后出现的恶心、反酸症状而退出试验.②醋酸钙联合低钙透析液治疗组在治疗后第3个月时血钙、血磷及钙磷乘积水平明显降低,血iPTH浓度明显升高,与对照组相比均有统计学差异（P＜0.05）;至第6个月时血钙、血磷及钙磷乘积水平趋于稳定.③两组患者在研究期间除治疗组1人出现肌肉痉挛外,其余患者未见明显不良反应.结论 醋酸钙联合低钙透析液对于合并高钙血症和高磷血症的老年腹膜透析患者具有较好的治疗效果.     

Immunological defenses in CAPD

The high peritonitis rate of a subgroup of patients on continuous ambulatory peritoneal dialysis (CAPD) may be due to alterations of peritoneal defense mechanisms, i.e. opsonization, phagocytosis and bacterial killing. It has been demonstrated that peritonitis incidence and in vitro opsonization of bacteria are related to the concentration of IgG in the dialysate and to the ability of macrophages to produce fibronectin. In addition, a decreased macrophage bactericidal activity is found in those with a high incidence of peritonitis; intracellular survival of microorganisms may, therefore, occur despite intact phagocytosis. A disturbance in the release of lymphokines and monokines in some CAPD patients may also reduce the ability of peritoneal macrophages to kill bacteria. On the basis of these defects, which involve both humoral and cellular defense mechanisms, it may be possible to treat these patients using IgG and interferon-alpha intraperitoneally.     

CAPD patients as renal transplant patients

Most authors state that the continuous ambulatory peritoneal dialysis (CAPD) patient is not at increased risk when transplanted. These patients are always exposed to the risk of peritonitis, which may increase if patients are peritoneally dialyzed while immunosuppressed. The postoperative course of patients transplanted from our CAPD program from 1979 through August 1985 was evaluated. The transplant survival of patients dialyzed by CAPD, home hemodialysis, and at a free-standing dialysis facility were compared. Pretransplant dialysis modality did not influence long-term transplant success. Three of seven patients who required dialysis postoperatively developed peritonitis. The dialysis catheter was removed in two patients and one was treated by lavaging the peritoneal cavity with antibiotics. There was one instance of dialysate leaking through a drain in the transplant bed. This patient was converted to hemodialysis for subsequent dialysis. The dialysis catheters were removed at the time of discharge from hospital. Literature review confirmed this experience. Peritoneal dialysis post-transplant exposes the patient to a 10-33% risk of peritonitis and a 10% risk of a wound complication. Peritoneal dialysis patients are subject to risks unique to peritoneal dialysis. These complications do not translate into excessive morbidity or graft loss.     

Relapsing peritonitis in a patient undergoing continuous ambulatory peritoneal dialysis due to Corynebacterium aquaticum

Corynebacterium aquaticum was the cause of peritonitis in a 33-year-old diabetic woman on continuous ambulatory peritoneal dialysis (CAPD). This case represents the first reported instance of CAPD peritonitis due to this organism. Moreover, the organism was recovered from fibrin clots removed from dialysate bags when the patient was on antibiotic therapy. Routine cultural methods failed to reveal the organism at that time. The organism is described and key points differentiating it from similar organisms are emphasised. The world literature on C. aquaticum infections is reviewed.     

A 2 year evaluation of diabetic patients on continuous ambulatory peritoneal dialysis

Nineteen diabetic patients with end-stage renal disease on CAPD were evaluated over a 2 year period. All but one patient was insulin-dependent, with a mean age of 47.7 years. Average time on CAPD was 16.1 months (range, 2–28 months). Thirteen patients were followed for more than 12 months, and nine for more than 18 months. The mean training period was 22.9 days. Good blood glucose control was obtained with intraperitoneal (IP) insulin in all of the patients. Mean blood glucose levels of 125±23.08 mg/dl were achieved with 103±38.5 U/day of regular IP insulin. Glycosalated hemoglobin decreased from a mean of 12.7±2.35% before CAPD to 10.08±0.97% during CAPD. Peritoneal creatinine clearance remained stable during the study period, with a concommitant decrease (P<0.001) in the mean residual renal creatinine clearance. The incidence of peritonitis was one episode per 7.8 patient-months. Average length of hospitalization was 33.24 days/year. Visual acuity remained stable after 1 year in 73% of the 26 eyes evaluated. No amputations were required in move than 2 years of follow-up. Actuarial survival was 100% at 1 year and 86% at 2 years, and the technique survival of CAPD was 91 and 79%, respectively. These results demonstrate that CAPD is a good dialysis procedure for treating diabetic patients with chronic renal failure, and it offers the advantage of controlling glycemia better than other dialysis methods.     

CAPD peritonitis after colonoscopy: follow the guidelines

We present two cases of peritonitis shortly after endoscopic examination of the large bowel with polypectomy in patients on continuous ambulant peritoneal dialysis (CAPD) despite the standard preventive measure to drain the dialysate from the abdomen prior to the procedure. We have reviewed the current literature on this topic. These cases demonstrate that the administration of prophylactic broad-spectrum antibiotics next to the drainage of the abdomen prior to colonoscopy in CAPD patients should be considered as recommended in the International Society for Peritoneal Dialysis (IS PD) guidelines 2005.     

Tuberculous peritonitis in patients undergoing continuous ambulatory peritoneal dialysis: case report and review.

A case of tuberculous peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD) in a 37-year-old man who presented with fever, abdominal pain, and a malfunctioning Tenckhoff catheter is reported. The patient was initially treated for presumed bacterial peritonitis but remained febrile and had persistent abdominal pain and peritoneal fluid pleocytosis, despite broad-spectrum antibiotic therapy. Mycobacterium tuberculosis was isolated in a culture of peritoneal fluid, and the patient responded promptly to antituberculous therapy. More than 50 cases of tuberculous peritonitis complicating CAPD that have been reported in the English-language literature since the initial case was reported in 1980 are reviewed. The most common symptoms are fever (78%), abdominal pain (92%), and cloudy dialysate (90%); 76% of cases had a predominance of polymorphonuclear cells in peritoneal fluid. A smear for acid-fast bacilli or a culture was positive in 73% of cases. The peritoneal dialysis catheter was removed in 53% of cases, although this was rarely considered necessary for cure of tuberculosis. The attributable mortality rate is 15%, with the most significant factor being treatment delay (mean time from presentation to initiation of treatment, 6.74 weeks). We conclude that tuberculosis is an important diagnostic consideration for CAPD patients with peritonitis that is refractory to broad-spectrum antibiotics.     

The treatment of diabetic renal failure by continuous ambulatory peritoneal dialysis

During the 6-year period 1981-1987, 309 patients started chronic ambulatory peritoneal dialysis (CAPD), of whom 75 (24%) had diabetes. Despite severe peripheral vascular problems (20%), ischaemic heart disease (90%), and complete blindness (21%) the 1-year patient survival on CAPD was 88%. The actuarial patient survival for diabetic patients was similar to that of the non-diabetic cohort over the first 18 months but fell to 48% (compared to 70% in non-diabetic patients) at 3 years. Complications associated with CAPD, including the incidence of peritonitis, were no different between the diabetic and non-diabetic patient populations. Successful treatment for end-stage renal disease (ESRD) in diabetic patients can be achieved and justified in a liberal selection programme for the treatment of diabetic ESRD.