持续非卧床腹膜透析患者相关性腹膜炎的原因与防治

目的探讨影响持续非卧床腹膜透析(CAPD)患者发生腹膜炎的因素。方法慢性肾功能衰竭正在进行规律腹膜透析治疗的患者131例,其中54例发生88例次腹膜透析相关性腹膜炎。分别按是否合并糖尿病、文化程度、营养状况、操作环境等分组,比较腹膜炎发生率的组间差异。结果 88例次中,69例次(78.4%)细菌培养阳性,包括革兰阳性球菌48例次,革兰阴性菌19例次,真菌2例次。致病菌对头孢唑啉、庆大霉素、头孢他定、环丙沙星耐药性较高。相对于非糖尿病患者,糖尿病腹膜透析患者腹膜炎的发生率高。血红蛋白、血白蛋白浓度降低为腹膜炎发生的高危因素。结论腹膜透析相关性腹膜炎受多种因素影响。CAPD相关性腹膜炎细菌以革兰阳性球菌为多数;细菌培养及药敏试验结果对抗生素的选择有指导意义。

Causes analysis and treatment of peritoneal dialysis-related peritonitis

Objective To analyze the factors for influencing continuous ambulatory peritoneal dialysis(CAPD)-related peritonitis.Methods Of 131 patients with chronic renal failure undergoing regular peritoneal dialysis,54 patients(88 incidents) occurred CAPD-related peritonitis.The incidence of peritonitis was compared among the patients with diabetes mellitus,cultural level,nutritional status,operation environment and other subgroups.Results Of 88 incidents,69 incidents(78.4%) were bacteria culture positive(Gram-positive cocci for 48 incidents,Gram-negative bacillus for 19 incidents,fungal for 2 incidents).The resistance to cefazolin,gentamicin,ceftazidime,ciprofloxacin was higher.Compared with nondiabetic patients,the incidence of CAPD-related peritonitis in diabetic patients was higher.The decreased hemoglobin and serum albumin were the high risk factors for peritonitis.Conclusion CAPD-related peritonitis is affected by many factors.The majority of bacteria in CAPD-related peritonitis are Gram-positive cocci and the results of bacterial culture and drug sensitive test are important in guiding selection for antibiotics.