腹膜透析相关性腹膜炎的临床特点分析  

Clinical characteristics of peritoneal dialysis-related peritonitis

作　　者：金珍木[1] 李素蘋[1] 朱小春[2] 

机构地区：[1]温州医科大学定理临床学院肾内风湿免疫科,浙江温州325000 [2]温州医科大学附属第一医院风湿免疫科,浙江温州325000

出　　处：《中华医院感染学杂志》2014年第6期1435-1437,共3页Chinese Journal of Nosocomiology

基　　金：浙江省温州市科技计划基金项目(Y20080191)

摘　　要：目的探讨腹膜透析相关性腹膜炎的临床特点,提高患者的临床疗效,从而降低相关性腹膜炎的发生率。方法随机选取医院2009年8月-2013年2月收治的腹膜透析相关性腹膜炎93例患者,对其进行细菌培养,观察多重感染性腹膜炎的例数,采用法国生物梅里埃公司AKB法进行病原菌鉴定及对抗菌药物敏感试验,分析患者的转归,采用SPSS 13.0软件进行数据统计。结果在93例感染患者中发生多重感染性腹膜炎共24例,占25.8%,其中有2例为两种真菌感染、5例为真菌与革兰阳性菌混合感染、2例为真菌与革兰阴性菌混合感染、4例为两种革兰阳性菌感染、3例为单纯两种革兰阴性菌感染、6例为革兰阳性菌与革兰阴性菌混合感染;对革兰阳性菌最敏感的为万古霉素,敏感率达100.0%,其次是利福平和加替沙星,均为94.0%;对革兰阴性菌最敏感的为美罗培南,敏感率为100.0%,常规用药如庆大霉素和头孢他啶的敏感性较低,分别为64.0%和55.0%,抗菌药物对真菌的敏感率均较好;24例多重感染性腹膜炎患者中17例继续进行腹膜透析,占70.8%,5例退出腹膜透析并改为血液透析治疗,占20.8%,2例死亡,病死率8.4%;在其余69例单一性腹膜炎感染患者中,57例继续进行腹膜透析,占82.6%,10例退出腹膜透析改为血液透析继续治疗,占14.5%;2例死亡,病死率2.9%。结论研究腹膜透析相关性多重感染性腹膜炎的临床特点,包括主要致病菌及其对抗菌药物的敏感性、发病患者的转归,可以有效预防腹膜透析相关性多重感染性腹膜炎的发生,且为临床用药提供理论依据。OBJECTIVE To explore the clinical characteristics o（ peritoneal dialysis-related peritonitis and improve the clinical efficacy so as to reduce the incidence of peritoneal dialysis-related peritonitis. METHODS A total of 93 patients with peritoneal dialysis-related peritonitis, who were treated in the hospital from Aug 2009 to Feb 2013, were enrolled in the study, then the bacterial culture was conducted, the number of the cases of multiple infectious peritonitis was observed, the identification of pathogens was carried out by using AKB method of BioMfirieux, France, the drug susceptibility testing was performed, the prognosis was analyzed, and the statistical anaIysis was performed with the use of SPSS 13.0 software. RESULTS Of the 93 patients with infections, the multiple infec- tious peritonitis occurred in 24 cases with the incidence of 25.8 %, including 2 cases of fungal infections, 5 cases of mixed infections with fungi and gram-positive bacteria, 2 cases of mixed infections with fungi and gram-negative bacteria, 4 cases of infections caused by two species of gram-positive bacteria, 3 cases of infections caused by two species of gram-negative bacteria, and 6 cases of mixed infections with gram-positive bacteria and gram-negative bacteria. The drug susceptibility rate of the gram-positive bacteria to vancomycin was the highest （100.0 %）, followed by rifampicin （94.0%） and gatifloxacin （94.0%）; the drug susceptibility rate of the gram=negative bacteria to meropenem was the highest （100.0%）, and the drug susceptibility rates to the commonly used antibiotics such as gentamicin and ce（tazidime were 64.0 %and 55.0%, respectively; the fungi were highly susceptible to the antibiotics. Of the 24 patients with multiple infectious peritonitis, 17 patients underwent the peritoneal dialysis, accounting for 70.8%, 5 cases quit the peritoneal dialysis and changed to hemodialysis, accounting for 20.8% and 2 cases died with the mortality rate of 8.4%. Among the 69 patients with single peritonitis, 57 case

关 键 词：腹膜透析 腹膜炎 临床特点 

分 类 号：R572.2[医药卫生—消化系统]