持续非卧床腹膜透析退出患者相关临床分析

目的分析持续非卧床腹膜透析(CAPD)患者死亡和转血液透析(HD)治疗的原因。方法回顾性分析40例CAPD患者的完整病历资料,调查其退出原因和感染病原菌、营养检查等指标。结果 16例死亡患者主要死亡原因为心脑血管疾病37.5%(6/16)、肺部感染37.5%(6/16)、腹透相关性腹膜炎(PDAP)12.5%(2/16);56.3%(9/16)的死亡患者HB90g/L,ALB30g/L。24例转HD的原因分别为PDAP45.8%(11/24)、透析不充分29.2%(7/24)、腹透管功能障碍20.8%(5/24)。结论腹膜透析(PD)患者死因为心脑血管疾病、肺部感染、PDAP,与营养状况不良有关。而PD患者退出转HD治疗的首要原因是PDAP,其次是透析不充分及导管功能障碍。     

腹膜透析患者中途退出原因分析及护理

目的:分析持续腹膜透析(CAPD)患者中途退出原因及影响因素,并提出护理对策。方法:调查2005年1月～2010年12月176例行CAPD患者临床资料,其中68例中途退出,分析其中途退出原因,并提出护理对策。结果:本组176 CAPD患者中途退出68例,其中死亡38例、转血液透析23例、肾移植5例、其他2例。死亡主要原因为心脑血管疾病,转血液透析主要原因为腹膜透析相关性腹膜炎。结论:CAPD患者中途退出主要原因为心脑血管事件及腹膜炎。规范护士操作、加强患者营养、提高其自我管理能力可降低CAPD患者中途退出率,提高生存质量。     

腹膜透析患者退出原因分析

目的通过对腹膜透析患者退出原因的分析讨论防治对策。方法回顾分析我科1999～2006年27例持续性不卧床腹膜透析（CAPD）患者并分析统计其退出原因。结果共有11例病人退出腹膜透析，占40．7％。主要原因为腹膜炎（63．6％），超滤衰竭（11．1％），经济困难放弃治疗（18．1％）。结论腹膜炎和超滤衰竭是退出腹膜透析的主要原因，应严格无菌操作尽早控制感染，限制水盐摄入，加强终末期肾病的一体化治疗。     

HMG-CoA还原酶抑制剂在腹膜透析相关性腹膜纤维化防治中的应用

腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)是终末期肾脏病(End Stage Renal Disease,ESRD)替代疗法的重要手段之一,在临床上已得到广泛应用.长期腹膜透析治疗的维持有赖于腹膜保持良好的功能,但临床上常由于各种原因如:腹膜透析液的生物不相容性、长期腹透引起透析相关性腹膜炎以及ESRD患者存在全身微炎症状态等导致腹膜纤维化[1],最终超滤失败(ultrafiltration failurle,UUF),这是透析技术性失败和腹透患者退出腹透治疗的主要原因.因此临床上如何正确合理使用药物和改善腹透液本身以防治腹膜纤维化,是目前腹膜透析中亟待解决的问题,也是当前研究的热点.     

45例腹膜透析患者腹膜透析管位置的观察

腹膜透析(peritoneal dialysis,PD)是尿毒症患者常用的肾脏替代治疗方法,而腹膜透析患者的腹透管移位是影响腹膜透析技术生存的主要原因之一.本观察统计了本院自1999年开展腹膜透析以来45例持续性不卧床腹膜透析(CAPD)患者腹膜透析管的位置情况,报道如下.     

终末期肾病患者腹膜透析转血液透析原因分析

目的 观察本院1993年来终末期肾病患者腹膜透析转向血液透析的原因。方法 回顾性分析上海市第一人民医院1993～2000年间腹透失败改行血透治疗的病人,退出原因分为1.腹腔感染;2.失超滤;3.透析不充分;4.腹透管问题;5.明显胸腔积液;6.其它原因。统计各自百分率并与相关报道作比较。结果 266例腹透患者中有66例改为血透治疗,对其中55例(在我院改血透且资料完整)进行分析。患者平均腹透时间为18.1月。腹透早期(透析时间<6月)退出原因百分比分别为15.8％、5.2％、21％、26.4％、10.5％和21％。长期腹透患者(透析时间≥12月)分别为46.7％、23.3％、10％、0％、6.7％和13.3％。结论 早期的腹透管问题及后期的腹腔感染和失超滤是腹透失败转血透的主要原因,失超滤常继发于腹腔感染。     

持续非卧床腹膜透析患者退出透析原因分析及护理

[目的]探讨持续非卧床腹膜透析（CAPD）患者退出透析的原因及护理对策.[方法]82例透析患者中16例患者退出腹膜透析,分析其原因,并总结护理经验.[结果]82例行CAPD患者中16例退出透析（19.5%）,其中因心血管事件死亡8例,腹透液引流不畅转血透1例.[结论]全面评估患者,加强对患者的个体化指导培训和管理是重要的护理措施.     

持续性非卧床腹膜透析患者退出原因分析与对策

目的通过对腹膜透析（PD）患者退出原因的分析,探讨防治对策。方法回顾分析因慢性肾功衰竭（CRF）接受持续性非卧床腹膜透析（CAPD）患者的临床资料,了解退出原因,并分析死亡病例的死因。结果共有135例患者符合条件,因各种原因退出PD共35例,退出率为25．9％（35／135）。其中死亡20例,转血液透析（HD）6例,肾移植9例。结论死亡是CAPD患者短期内退出PD的主要原因,而心血管事件、腹膜炎是导致CAPD患者死亡的主要原因。因此应积极加强透析前的一体化治疗及PD患者透析后的持续管理。     

腹膜透析管漏液处理方法

腹膜透析是终末期肾脏疾病患者一种重要的替代治疗方法, 目前已在世界各地广泛开展, 受到越来越多的重视.腹膜透析通路的完好性是腹膜透析的必备条件之一, 然而各种原因引起的腹透管( 包括隧道内、体外段)任何一处渗漏均可使腹膜炎的发生率成倍升高,重者可能需退出腹透治疗.     

腹透管的单向阻塞与疏通

持续性不卧床腹膜透析(CAPD)目前已成为治疗慢性肾功能衰竭(CRF)的主要方法之一。在行CAPD的过程中,由于腹透管单向阻塞引起的透析液引流不畅,是CAPD的主要并发症。本文回顾性分析了近5年中75例在CAPD过程中发生腹透管单向阻塞患者的临床资料,旨在探讨腹透管单向阻塞的处理措施,降低因导管阻塞而重新植管或停止腹透的发生率。     

Continuous ambulatory peritoneal dialysis and renal transplantation: a ten-year experience in a single center.

OBJECTIVE: To assess whether a renal graft outcome is dependent on the modality of dialysis prior to transplantation and to assess risk of peritonitis and catheter-related problems posttransplantation. DESIGN: Retrospect analysis of the outcome of a first cadaveric renal transplantation from hemodialysis (HD) and CAPD patients over a ten-year period. PATIENTS: Out of a total of 905 renal transplants over a ten-year period, 699 were first grafts; 500 of these (241 on CAPD, 259 on hemodialysis) were analyzed while the remaining (incomplete data, predialysis, pediatric) were assessed for graft and patient survival only. MAIN OUTCOME: Graft and patient survival cases were identical in the two groups (five-year graft survival: CAPD 67%, hemodialysis 66%; five-year patient survival: CAPD 88%, hemodialysis 87%). CAPD posttransplant was necessary in 37 patients, while 10 developed peritonitis mostly related to CAPD use and responded to appropriate therapy. Routine catheter removal posttransplant was undertaken between 8 and 12 weeks. CONCLUSION: Excellent graft and patient survival is achieved independent of the modality of dialysis prior to transplantation. Peritoneal dialysis can be used postgrafting, but there is a risk of peritonitis, which can be successfully managed with antibiotics and catheter removal. Great care is needed in executing the dialysis and catheter care after transplantation.     

Tenckhoff catheter replacement or intraperitoneal urokinase: a randomised trial in the management of recurrent continuous ambulatory peritoneal dialysis (CAPD) peritonitis

A randomised trial, comparing Tenckhoff catheter replacement as a one-stage procedure and i.p. urokinase, was undertaken in the management of recurrent continuous ambulatory peritoneal dialysis (CAPD) peritonitis. In addition to appropriate i.p. antibiotic treatment, 17 patients received i.p. urokinase (5000 i.u.) on the second and fourth days of antibiotic treatment, and 14 patients underwent CAPD catheter replacement. An additional six patients also underwent catheter replacement following the recurrence of peritonitis after urokinase treatment. The subsequent recurrence rate of peritonitis following CAPD catheter replacement (5%) was significantly less than after urokinase (41%) (p less than 0.001). Fourteen patients remained free of peritonitis for at least three months after catheter replacement, and five patients were peritonitis-free following urokinase for this period.     

Prevalence and management of hernias in peritoneal dialysis patients.

OBJECTIVES: The aim of this study was to assess the prevalence of hernias before and after the start of continuous ambulatory peritoneal dialysis (CAPD) in patients with end-stage renal disease, and to evaluate the result of a proposed surgical treatment. DESIGN: Prospective observational study. SETTING: University hospital. PATIENTS: 122 patients who started CAPD from 1994 to 2000; 26 hernias were diagnosed in 21 (17.2%) patients. MAIN OUTCOME MEASURES: Finding of hernias; morbidity associated with catheter insertion and hernia repair; recurrence of hernias. Results: 19 hernias were detected in 15 patients (12.3%) before they began CAPD; only 7 hernias were observed while on CAPD. Umbilical (61.5%) and inguinal (26.9%) hernias were the most common. Multiple hernias were detected in 4 patients. Simultaneous repair of hernia and catheter insertion was performed in patients with pre-existing hernias. Under local anesthesia, most patients were operated on with surgical techniques of tension-free hernioplasty using a polypropylene mesh. Only mild post-operative complications were recorded: 3 seromas and 1 hematoma. No fluid leakage was found in our series. There were no long-term complications (infection or recurrence) related to the mesh. CONCLUSIONS: 73% of hernias in peritoneal dialysis patients occur before starting dialysis. Hernia problems in these high-risk patients can be safely solved using a careful technique with application of tension-free hernioplasty. Most may be repaired under local anesthesia with simultaneous catheter insertion.     

Peritonitis-related deaths in continuous ambulatory peritoneal dialysis (CAPD) patients

A total of 636 episodes of peritonitis occurred in 440 patients who entered our continuous ambulatory peritoneal dialysis (CAPD) program from September 1977 to February 1988. Sixteen patients (8 male and 8 female, aged 37-77 years) died during an episode of peritonitis (fatality rate 2.5%). They had been on CAPD for 3 to 105 (average 39) months. Six of them were diabetics. The peritonitis rate among these 16 patients were 1 episode per 12 patient months, while the corresponding figure for the whole (440) CAPD population was 14 patient months. Risk factors present in the 16 patients were: cardiovascular disease (12), cerebrovascular accident (2) peripheral artery disease (1) and pulmonary fibrosis (1). Fever and leukocytosis were present on admission in 11 patients, while total serum proteins and albumin were significantly lower (p less than 0.001) than the corresponding values before peritonitis (56 +/- 8 vs. 65 +/- 5). Staph. aureus was isolated in 8 patients (50%), multiple organisms in 6, Pseudomonas and Candida albicans in 1 each. An abdominal abscess was found in 4 (25%) patients. The peritoneal catheter was removed between the 5th and 10th day in 6 and after the 10th day in 7 patients. Peritonitis with sepsis was the cause of death in 13 patients. Contributing factors were cardiovascular accident in 9, uremic coma in 2, extensive GI bleeding in 2, GI perforation in 2, intestinal infarction in 1, and pneumonia in 2 patients. We conclude that the risk of peritonitis-related death in CAPD patients is increased with Staph. aureus or multibacterial peritonitis. Contributing factors are concomitant cardiovascular disease and delayed (greater than 5 days) catheter removal.     

Does previous abdominal surgery increase postoperative complication rates in continuous ambulatory peritoneal dialysis?

BACKGROUND: This study was to compare the postoperative complication rates of continuous ambulatory peritoneal dialysis (CAPD) catheter insertion via open technique between two groups of patients, those with and those without a history of previous abdominal surgery. METHODS: A review was carried out in 122 patients over a 2-year period. The patients were divided into two groups: those with and those without previous lower abdominal surgery. All patient records were retrospectively analyzed until the time of catheter failure or to current time if alive and receiving CAPD. Patient characteristics, operative factors, and postoperative complications were recorded. RESULTS: Postoperative complications were reported as catheter malfunction in 16 patients and CAPD-related peritonitis in 36 patients. The complication rates in the group of patients with previous abdominal surgery were 16.7% catheter malfunction and 33.3% CAPD-related peritonitis. In patients without previous lower abdominal surgery, a catheter malfunction rate of 12.5% and a peritonitis rate of 28.8% were seen. The operation time in patients with previous abdominal surgery was longer than that in patients without previous abdominal surgery. However, no statistically significant difference in postoperative complication rates was detected between patients with and patients without previous lower abdominal surgery. CONCLUSION: CAPD remains a reliable modality in the treatment of end-stage renal disease and does not increase postoperative complications in patients with previous abdominal surgery.     

Combined abdominal hernia repair and continuous ambulatory peritoneal dialysis (CAPD) catheter insertion

Out of a series of 290 surgically inserted continuous ambulatory peritoneal dialysis (CAPD) catheters, 19 patients had 24 abdominal hernias repaired at the same time as CAPD catheter insertion. All catheters were used immediately after our normal postoperative break in protocol. There were no fluid leaks from the hernia repair site but 3 catheters failed due to complications unrelated to the hernia repair. CAPD technique survival was not adversely affected in the hernia repair group.     

持续非卧床式腹膜透析患者合并继发性腹膜炎

目的 了解持续非卧床式腹膜透析（continuous ambulatory peritoneal dialysis,CAPD）合并继发性腹膜炎的临床表现特点,以提高对此症的诊治水平。方法对在2003年1月～2003年4月期间澳门仁伯爵综合医院肾科收治的3例CAPD患者合并继发性腹膜炎的临床资料进行回顾性分析,并以同期收治的8例CAPD相关性腹膜炎为对照组,对两组患者的年龄、CAPD时间和化验结果进行统计分析。结果3例继发性腹膜炎患者均为女性,年龄（75.3±5.5）岁,既往无腹膜炎史。在入院时,所有患者均被误诊为CAPD相关性腹膜炎。对两例患者进行腹部X线平片检查分别可见膈下游离气体和小肠梗阻征象。治疗延误3～28天,最后诊断分别为回肠穿孔、乙状结肠缺血性坏死和绞窄性切口疝。两组患者的年龄、血红蛋白、血白细胞（WBC）、血清白蛋白、C反应蛋白（CRP）和入院时腹膜透析液WBC计数（D1）无显著性差异（P〉0.05）;继发性腹膜炎和CAPD相关性腹膜炎的不同点表现在：①CAPD时间明显长[（24.6±7.5）月vs（10.5±8.2）月,P=0.035];②多数患者在发病早期可见粉红色腹膜透出液;③对抗炎治疗效果差（P〈0.05）;④病死率高（67%vs 0）。结论CAPD患者合并继发性腹膜炎的临床表现和CAPD相关性腹膜炎有所不同,其临床误诊率和病死率高,应引起临床医生重视。     

A comparative analysis on the incidence of peritonitis and exit-site infection in CAPD and automated peritoneal dialysis.

OBJECTIVE: To compare the incidence of peritonitis and exit-site infection in an ample group of patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis in a single center during a 10-year period. DESIGN: Nonrandomized, prospective study. SETTING: Public, tertiary care hospital providing peritoneal dialysis care to a population of (approximately) 750 000 people. PATIENTS: We studied 213 patients on CAPD and 115 on automated peritoneal dialysis (APD) starting therapy between January 1989 and August 1998, with a minimum follow-up of 3 months. MAIN OUTCOME MEASURES: Using a multivariate approach, we compared the incidence, clinical course, and outcome of peritonitis and exit-site infections in both groups, controlling for other risk factors for the complications studied. RESULTS: The incidence of peritonitis was higher in CAPD than in APD (adjusted difference 0.20 episodes/ patient/year, 95% confidence interval 0.08 - 0.32). There was a trend for CAPD patients to present earlier with peritonitis than APD patients, yet the incidence of and survival to the first exit-site infection were similar in both groups. The etiologic spectrum of infections displayed minor differences between groups. Automated PD patients were more frequently hospitalized for peritonitis, but otherwise, the complications and outcome of peritonitis and exit-site infections did not differ significantly between patients on CAPD and those on APD. CONCLUSIONS: Automated PD is associated with a lower incidence of peritonitis than is CAPD, while exit-site infection is similarly incident under both modes of therapy. The etiologic spectrum, complications, and outcome of peritonitis and exit-site infection do not differ markedly between CAPD and APD. Prevention of peritonitis should be included among the generic advantages of APD over CAPD.     

65例持续性非卧床腹膜透析腹膜炎相关因素分析

目的探讨单中心持续性非卧床腹膜透析(CAPD)患者发生腹膜炎的相关因素。方法回顾性分析该院腹膜透析中心2010年1月至2014年12月随访的181例CAPD患者中65例腹膜炎患者的相关因素。结果65例腹膜炎患者共发生腹膜炎98例次,腹膜炎平均发生率为0.24次/年。引起腹膜炎的相关因素有操作不规范、低蛋白血症及低钾血症。结论腹膜炎的发生与操作不规范、营养不良、电解质紊乱等密切关系。加强CAPD患者的培训及科学的膳食营养,具有重要的临床意义。     

Peritonitis due to Aspergillus and zygomycetes in patients undergoing peritoneal dialysis: report of 2 cases and review of the literature

Fungal peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) has been associated with high mortality and high CAPD-discontinuation rates. Most cases are due to Candida spp. while Aspergillus spp. and zygomycetes have only rarely been implicated. We report one case each of CAPD-related peritonitis caused by Aspergillus terreus and Mucor sp., which have previously been described in the literature once and twice, respectively. The former had a slowly progressive course, did not respond to amphotericin B (AB), and died; the latter improved after a prolonged course of liposomal-AB. Among reported cases of CAPD-related peritonitis due to molds (22 Aspergillus spp. and seven zygomycetes), previous bacterial peritonitis was a common event, the related mortality associated with Aspergillus and zygomycetes was 27% and 57%, respectively, prompt removal of the Tenckoff catheter was critical for survival, and most patients were not able to resume CAPD.