预防性外用莫匹罗星对于腹膜透析患者导管出口评分的影响

目的探讨用出口评分（Exit-Site Score,ESS）法评分进行腹膜透析（CAPD）导管出口感染的辅助诊断,观察莫匹罗星治疗对于出口评分的影响。方法选取在上海交通大学附属第一人民医院肾内科行腹膜透析的80例患者,运用横断面调查的方法,采用腹膜透析患者出口评分法来进行评分。对于ESS2～3分者,随机分成两组,一组予以常规的每日清洁,另一组在此基础上进行每日在出口处涂擦莫匹罗星乳膏1个月,再次进行相关的评分。然后对于所有的ESS评分为2～3分的糖尿病患者以及浅表涤纶套距离皮肤较近者（〈1.5cm）,皆采用每日在出口处涂擦莫匹罗星乳膏,累计1个月的治疗,观察其后ESS评分的改善。结果①80例患者中,ESS评分≥4分者有3例,占3%;2～3分者有21例,占26%;ESS评分为0分者40例,占50%,2～3分者平均的评分为（2.7±0.6）分;②治疗组出口处评分经过一个月的治疗,ESS评分≥4分者有1例,以后发展到腹膜炎;2～3分者平均的评分为（2.2±0.5）分,较治疗前明显改善,P〈0.05。与对照组相比,治疗组的ESS评分明显改善,而对照组与治疗前评分无明显的差异;③糖尿病患者与浅表涤纶套离开皮肤较近者（1．5cm），其ESS评分明显升高，而经过使用抗生素乳膏，ESS评分皆能获得改善。结论本研究提示对ESS评分≥2分者进行莫匹罗星治疗可以明显改善出口评分状况，从而可能影响其腹膜炎的发生。

Effect of preventive local application of mupirocin on exit-site score in peritoneal dialysis patients

Objective Catheter infections including exit-site and tunnel infections can result in peritoneal dialysis-related infections, leading to catheterization failure. Recently, the Exit-Site Score （ESS） has been used in children to diagnose the infection at the exit site. ESS may be more convenient and practical than microbiological methods. The objective of this study was to evaluate the effect of mupirocin on ESS in continuous ambulatory peritoneal dialysis （CAPD） patients. Methods We used cross-section method to study 80 CAPD patients treated in this dialysis center. ESS was judged by 5 clinical presentations： erythema （none, 0; 〈 0.5cm, 1; 〉 0.5cm, 2）, crust （none, 0; 〈 0.5cm, 1; 〉 0.5cm, 2）, tenderness （none, 0; moderate, 1; severe, 2）, swelling （none, 0; moderate, 1; severe, 2）, and discharge （none, 0; clear, l; purulent, 2）. ESS score 4 or greater was considered as having exit-site infection, and that of less than 4 may or may not have infection. We chose 21 patients with ESS score 2 or 3, and randomly assigned them into treatment group （n = 10） or control group （n = 11）. For treatment group, mupirocin was applied on the exit of peritoneal catheter everyday. For control group, only routine clean procedure was used. ESS was judged again after one month. Results （1） In the 80 peritoneal dialysis patients, ESS score 4 or more than 4 were found in 3 cases （3%）, ESS scores 2-3 were found in 21 cases （26%） with the average score of 2.7 ± 0.6, and ESS score 0 was found in 40 cases （50%）. （2） In the treatment group, the average ESS score decreased from 2.7 ± 0.6 to 2.2 ±0.5 （P 〈 0.05） after the treatment for one month. In control group, however, ESS score had no significant change after one month. （3） In diabetic patients on peritoneal dialysis with the distance less than 1.5cm between superficial cuff and skin, ESS score was usually greater than that in non-diabetic patients, and their ESS score decreased significantly （P 〈 0.05） after local application of mupirocin. Conclusion Local application of mupirocin on the tube exit site was useful for the improvement of ESS score in patients with ESS score 2-3. More studies are needed to elucidate whether this treatment can lower the peritonitis incidence in CAPD patients and to find out the treatment for the patient with refractory infection at the exit site.