持续性不卧床腹膜透析相关性腹膜炎:3年108例次分析

背景:腹膜炎是终末期肾衰竭患者在进行持续性不卧床腹膜透析治疗中最常见的并发症,处理不当可导致腹膜炎反复发作.近年来虽在腹膜头四管道装置设计等方面做了很多努力及改进,但仍难以避免.目的:探索持续性不卧床腹膜透析并发感染性腹膜炎的相关因素及治疗方法.方法:选择因终末期肾脏疾病接受持续性不卧床腹膜透析治疗的住院及门诊患者115例,其中男性55例,女性60例,年龄(56.2±8.7)岁,其中68例患者并发感染性腹膜炎108例次,年龄(58.5±8.3)岁.接受持续性不卧床腹膜透析治疗(30.3±5.5)个月.调查持续性不卧床腹膜透析患者的营养状态、是否并存糖尿病、文化背景、家居环境及是否专人操作,并分析这些因素与并发感染性腹膜炎的关系.采取病原学检查致病菌,通过腹腔冲洗、全身及腹腔内二种途径使用抗生素抗感染治疗.腹膜炎期间停止持续性不卧床腹膜透析,改血液透析替代治疗.结果与结论:营养状况好,家居环境好、文化程度高、有专人操作的持续性不卧床腹膜透析患者不易发生感染性腹膜炎;持续性不卧床腹膜透析合并糖尿病患者较易发生.采取腹腔冲洗、全身及腹腔内应用抗生素及腹膜炎期间改血液透析治疗有效.其致病菌以革兰阳性球菌为主,对万古霉素,头孢唑林敏感;革兰阴性杆菌对依替米星,阿米卡星、亚胺培南西司他丁敏感.持续性不卧床腹膜透析腹腔感染受多种因素影响,建议腹膜透析患者应加强营养、改善家居环境,严格注意无菌操作;医生应选择适宜患者给予腹膜透析.

Peritonitis complicated with continuous ambulatory peritoneal dialysis: Analysis of 108 cases in 3 years

BACKGROUND: Peritonitis is the common detective complications at the end-stage of renal failure patients during continuous ambulatory peritoneal dialysis (CAPD) treatment, which easily repeatedly occurred if not handled properly. Although the plumbing designs of peritoneal dialysis have done a lot of effort and improved in recent years, it still hard to avoid. OBJECTIVE: To explore the relative factors and treatments of infectious peritonitis complicated with CAPD. METHODS: Totally 115 cases received CAPD were selected, including 55 males and 60 females, aged (56.2?.7) years. 68 cases of which were suffered infectious peritonitis, aged (58.5?.3) years. All received a (30.3?.5)-month CAPD treatment. The relative factors such as the nutrition situation, whether complicated with diabetes mellitus or not, culture background, domestic environment, whether operating by special person and so on were investigated, and the relationship between those factors and infectious peritonitis were analyzed. The pathogen method was used to check pathogenic bacteria, and those patients were treated with irrigation of abdominal cavity and antibiotics in two ways, that is, systemic and intra-abdominalcavity. Hemodialysis instead of CAPD was used in those infectious peritonitis patients.RESULTS AND CONCLUSION: Those patients with good nutrition situation, higher culture background, better domestic environment, and operating by special person had low chances to infect peritonitis. And those patients with diabetes mellitus had high chances to infect peritonitis. Treatments of abdominal cavity and anti-infection in two ways-systemic and intra-abdominal cavities were effective to those infectious peritonitis patients. Gram-positive bacteria were the most common pathogen, which were susceptive to vancomycin and cefazolin. If the pathogen was gram-negative bacteria, etimicin sulfate, amikacin, and imipenem cilastatin could be selected. Infectious peritonitis complicated with CAPD affected by many factors. CAPD patients should be provided better nutrition and domestic situation. Also patients should operate in aseptic ways. Doctors should choose proper patients who can operate CAPD right.