腹膜透析相关性腹膜炎临床特征的单中心研究  

The Clinical Characteristics of Peritoneal Dialysis-related Peritonitis: Experience from a Single Center Study

作　　者：万启军[1] 朱丹[1] 李晶[1] 何永成[1] 

机构地区：[1]深圳大学第一附属医院,深圳市第二人民医院,广东深圳518035

出　　处：《深圳中西医结合杂志》2015年第5期1-3,共3页Shenzhen Journal of Integrated Traditional Chinese and Western Medicine

基　　金：深圳市科技计划项目(201202049)

摘　　要：目的:探讨腹膜透析相关性腹膜炎发生的原因及其相关因素。方法:回顾分析2012年8月-2014年8月间深圳市第二人民医院腹膜透析相关性腹膜炎患者56例(67例次)的临床资料,比较腹膜炎组与非腹膜炎组患者在基础疾病、透析龄、年龄、患者依从性、营养状态、居住地等方面的差异;总结患者腹膜炎的原因、发生的季节、病原菌及药物敏感性、临床转归等特点,探讨本中心腹膜透析相关性腹膜炎的临床特征。结果:本中心腹膜透析相关性腹膜炎的发生率为1次/49.3患者月。腹膜炎的主要感染途径:接触污染者22例(39.3%),肠源性18例(32.1%)。糖尿病、低白蛋白、仍服用强的松或免疫抑制剂是腹膜透析相关性腹膜炎的独立危险因素。腹透液培养阳性53例次(79.1%),其中,革兰阳性球菌29例次(54.7%)、革兰阴性杆菌22例次(41.5%)、真菌感染1例次(1.9%)、结核性腹膜炎1例次(1.9%)。未发现对万古霉素、亚胺培南、美罗培南的耐药菌株。夏、秋季腹膜透析相关性腹膜炎的发生率较高。结论:本中心腹膜透析患者发生腹膜透析相关性腹膜炎的主要原因为换液操作不规范和肠道感染;细菌仍以革兰阳性球菌为主;四季中以夏秋季常见;糖尿病、低白蛋白血症、仍服用强的松或免疫抑制剂是腹膜透析相关性腹膜炎的独立危险因素;有效治疗后腹膜透析退出率较低。Objective To investigate the causes and related factors of peritoneal dialysis-related peritonitis in a single center study. Methods 56 patients suffered from peritoneal dialysisrelated peritonitis and 96 peritoneal dialysis patients without peritonitis as control in our hospital were included from 2012 to 2014, and their gender, age and possible risk factors were analyzed by unvaried and multivariate logistic regression analysis. The causes, pathogenic bacteria, drug susceptibility were analyzed. Results The main causes for peritoneal dialysis-related peritonitis were nonstandard operating steps and intestinal infection. Multivariate logistic regression analysis showed that peritoneal dialysis-related peritonitis was significantly associated with lower albumin level, diabetes mellitus, still using steroids and anti-immunizasant. In the peritoneal fluid culture, 53 cases were found positive and the positive rate was 79.1%, 29 cases （54.7 %） were infected with Gram-positive coccid, 22 cases （41.5 %） with Gram-negative bacillus, 1 case （1.9 %） with tuberculosis and 1 case （1.9 %）with fungi. Drug sensitivity test showed that all bacilli were sensitive to imipenem, meropenem and vacomycin in all cases. Conclusions The main causes of peritoneal dialysis-related peritonitis in this centre are nonstandard operating steps and intestinal infection. The lower albumin level, diabetes mellitus, still using steroids and anti- immunizasant are independent risk factors of peritoneal dialysis-related peritonitis. Gram-positive coccid are the main pathogenic bacteria leading to peritoneal dialysis-related peritonitis.

关 键 词：持续非卧床腹膜透析 腹膜炎 临床特征 危险因素 

分 类 号：R459.5[医药卫生—治疗学] R656.41[医药卫生—临床医学]