单发性和多发性腹膜透析相关性腹膜炎的临床特征及预后对比分析  

Clinical Characteristics and Prognosis of Single /Multiple Episodes of Peritoneal Dialysis-related Peritonitis:A Comparative Analysis

作　　者：张蓓茹[1] 田密[1] 于锐[1] 白瑜[1] 吴岩[1] 张静娟[1] 李丹[1] 李德天[1] 

机构地区：[1]中国医科大学附属盛京医院肾内科,辽宁省沈阳市110004

出　　处：《中国全科医学》2014年第8期879-882,共4页Chinese General Practice

基　　金：辽宁省自然科学基金资助项目(201102272)

摘　　要：目的对比分析单发性和多发性腹膜透析相关性腹膜炎患者的临床特征及预后情况。方法回顾性分析2008年6月—2013年3月于盛京医院腹膜透析中心行腹膜透析的患者中发生单发性腹膜透析相关性腹膜炎与多发性腹膜透析相关性腹膜炎患者的临床特征及预后。结果共67例患者发生腹膜透析相关性腹膜炎,其中35例患者发生1次腹膜炎(单发组),27例患者发生2次腹膜炎、5例患者发生2次以上腹膜炎(多发组)。两组腹膜透析操作方式间差异有统计学意义(P<0.05),多发组血红蛋白和清蛋白水平〔(88.3±19.9)g/L,(28.4±8.1)g/L〕低于单发组〔(98.2±16.4)g/L,(32.6±6.3)g/L,P<0.05〕。单发组和多发组第1次腹膜炎的致病菌以革兰阳性球菌为主,多发组第2次腹膜炎的致病菌以真菌为主。单发组完全缓解21例、拔管8例、死亡6例,多发组完全缓解16例、拔管11例、死亡5例,两组预后间差异无统计学意义(χ2=1.108,P=0.575)。结论由保姆辅助腹膜透析操作、贫血及低蛋白血症患者易发生多发性腹膜透析相关性腹膜炎,且第2次腹膜炎时真菌感染增加,单发性和多发性腹膜透析相关性腹膜炎的预后相当,但仍需要采取有效措施纠正易患因素,进而控制多发性腹膜透析相关性腹膜炎的发生。Objective To analyze comparatively the clinical characteristics and prognosis of single/multiple episodes of peritoneal dialysis（PD） related peritonitis.Methods A retrospective analysis was carried out on the clinical characteristics and prognosis of 67 PD patients with single/multiple episodes of PD-related peritonitis.Results Thirty-five patients had 1 episode of PD-related peritonitis（group A）,27 had 2,5 had over 2（group B）.There was significant difference in PD operating mode between 2 groups（P＜0.05）.The levels of hemoglobin,albumin were lower in group B[（88.3±19.9）g/L,（28.4±8.1）g/L] than in group A[（98.2±16.4） g/L,（32.6±6.3）g/L,P＜0.05].The pathogenic bacteria of the first episode of peritonitis were mainly gram positive coccus in two groups,those of the second episode were mainly fungi.In group A,21 had complete remission,8 had extubation,6 died,and 16,11,5,respectively,in group B.There was no difference in prognosis between 2 groups（χ2=1.108,P=0.575）.Conclusion The anemia and hypoproteinemia patients who have nanny-aiding PD are prone to multiple episodes of PD-related peritonitis and fungal infection increases in the second episode.The single and multiple episodes of PD patients have the same prognosis,and the liability factors should be corrected by effective measures to control the incidences of multiple episodes of PD-related peritonitis.

关 键 词：腹膜透析 腹膜炎 预后 致病菌 

分 类 号：R656.41[医药卫生—外科学]