单中心3年腹膜透析相关性腹膜炎变化趋势分析  

Clinical changes of CAPD-related peritonitis in a period of 3 years in a single peritoneal dialysis center

作　　者：李天慧[1] 毛永辉[1] 赵班[1] 贾莺梅[1] 富小红[1] 

机构地区：[1]北京医院肾内科,北京100730

出　　处：《中国血液净化》2015年第2期75-78,共4页Chinese Journal of Blood Purification

摘　　要：目的分析本中心2011~2013年腹膜透析相关性腹膜炎发生率的变化原因,探讨降低腹膜炎发生的改进措施。方法以持续质量改进（continous quality improvement,CQI）模式回顾性分析比较2011~2013年腹膜透析相关性腹膜炎患者的一般情况、腹膜炎发生率及转归、病原菌分布、病因评估、患者培训频次。结果 2011~2013年腹膜透析相关性腹膜炎的发生率类似＂V＂型曲线变化,分别为48.8次/患者月,91.8次/患者月,27.9次/患者月,（P〈0.001）。G＋球菌发生率（P=0.030）、除肠球菌外的G＋球菌发生率（P=0.04）均呈＂V＂型曲线变化。肠源性腹膜炎呈逐年上升趋势（P=0.050）。2013年长透析龄患者中65岁以上患者比例升高（P=0.010）。2012年、2013年老患者年度培训率、患者总体培训率较2011年比明显降低（P〈0.001）。结论长透析龄中65岁以上老年患者比例增加,肠源性腹膜炎相关教育缺失,年度腹膜透析相关性腹膜炎培训频次不足是本中心2013年腹膜炎发生率增高的主要原因。Objective To investigate the clinical changes of CAPD-related peritonitis from 2011 to 2013 in a single peritoneal dialysis center in order to improve the preventive measures for the peritonitis. Methods Continuous quality improvement （CQI） method was used to analyze the demographic information, incidence, prognosis, pathogenic bacteria, cause of the peritonitis, and frequency of patient training in the CAPD-related peritonitis patients during the period from 201l to 2013. Results The CAPD-related peritoni- tis rate in 2011, 2012 and 2013 was one episode/48.8 patient-months, one episode/91.8 patient-month, and one episode/27.9 patient-month （P〈0.00I）, respectively, demonstrating a ＂V＂ profile of the incidence curve. The V-curve changes were also present in the incidences of Gram-positive cocci （P=0.03）, and Gram-positive coc- ci not including enterogenic bacteria （P=0.04）. The incidence of enterogenic peritonitis increased gradually in 2011 to 2013 （P =0.05）. In the patients with long-term peritoneal dialysis, the ratio of older patients （〉 65 years old） increased in 2013 （P=0.01）. The rates of annual patient re-training and over-all patient training in older patients were lower in 2012 and 2013 than in 2011 （P〈0.001）. Conclusion The increase of CAPD-re- lated peritonitis in 2013 in this peritoneal dialysis center probably resulted from the increase of older patients （〉65 years of age） in long-term peritoneal dialysis patients, insufficient education for the prevention of entero- genic peritonitis, and the less frequency of annual re-training for the prevention of CAPD-related peritonitis.

关 键 词：腹膜炎 G+球菌 肠源性细菌 再培训 

分 类 号：R459.5[医药卫生—治疗学]