腹膜透析相关性腹膜炎发生后就诊时间延迟及其预后不良影响因素分析  

The influence factors of onset to treatment time and its effects of clinical outcomes of peritoneal dialysis-related peritonitis

作　　者：曹沛仪[1] 易春燕[1] 叶红坚[1] 张小丹[1] 林小燕[1] 昌瑶 陈晶晶 林建雄[1] Cao Peiyi;Yi Chunyan;Ye Hongjian;Zhang Xiaodan;Lin Xiaoyan;Chang Yao;Chen Jingjing;Lin Jianxiong(Peritoneal dialysis center,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou,510080,China)

机构地区：[1]中山大学附属第一医院腹膜透析中心,广东广州510080

出　　处：《现代临床护理》2018年第9期38-44,共7页Modern Clinical Nursing

基　　金：广州市肾脏病临床医学研究与转化中心项目专项;项目编号为2014Y2-00543

摘　　要：目的探讨腹膜透析患者发生腹膜透析相关性腹膜炎就诊时间延迟及其预后不良影响因素,为优化腹膜炎患者就诊流程及改善患者预后提供科学依据。方法将在本中心规范治疗的328例腹膜透析相关性腹膜炎患者进行回顾性调查分析。了解患者腹膜透析相关性腹膜炎发生与预后情况,患者就诊时间延迟的影响因素与年轻患者(≤50岁)发生腹膜透析相关性腹膜炎预后的影响因素。结果 328例腹膜透析患者发生589例次腹膜透析相关性腹膜炎,其中治愈468例次(79.46%),不良预后121例次(20.54%);患者腹膜炎发生后就诊时间≤24h 426例次,占72.33%,25～72h就诊89例次,占15.11%,>72h就诊74例次,占12.56%;二元Logistic回归分析显示,居住地、血红蛋白、血清白蛋白、致病微生物类别是腹膜透析患者腹膜炎发生后就诊时间延迟的独立影响因素;在年轻腹膜透析相关性腹膜炎患者(≤50岁)中,腹膜炎发生后就诊时间、透析龄、致病微生物类别是腹膜炎治疗不良预后的独立危险因素。结论居住在市外或省外、较低的血红蛋白与血清白蛋白水平、不同的致病微生物类别是腹膜透析患者腹膜炎发生后就诊时间延迟的影响因素。就诊时间延迟、较长透析龄、不同的致病微生物类别是年轻腹膜透析相关性腹膜炎患者发生不良预后的独立危险因素。应建立规范的随访工作,指导患者定期随访,发生腹膜炎及时返院接受治疗,以改善患者的预后。Objective To explore the associated factors of the peritonitis onset to treatment time(OTT)and its influence on the clinical outcomes of peritoneal dialysis(PD)-related peritonitis.In order to provide evidence for a better treatment procedure and improving the prognosis of peritonitis.Methods This was a retrospective cohort study included 328 patients with PD-related peritonitis who initially received treatment in our PD center.The associated factors of delayed OTT of peritonitis were explored by binary Logistic regression models.The influence of delayed OTT on the clinical outcomes was analyzed in a subgroup patient with age≤50 years.Results A total of 589 peritonitis episodes in 328 patients were included in the study.Among them,468(79.46%)episodes were cured,while 121(20.54%)episodes occurred adverse outcomes.According to the different OTT,589 peritonitis episodes were divided into three groups:≤24 hours group(426 cases,72.33%),25~72 hours group(89 cases,15.11%)and>72 hours group(74 cases,12.56%).Binary Logistic regression models showed that,living out of the city,lower hemoglobin and albumin,different pathogenic microorganisms were independently associated with delayed OTT of peritonitis.In patients younger than 50 years,delayed OTT,longer dialysis duration and pathogenic microorganisms were independent risk factors of adverse outcomes of peritonitis.Conclusion Living out of the city,lower hemoglobin,and albumin,different pathogenic microorganisms were independently associated with delayed OTT of peritonitis.Delayed OTT,longer dialysis duration,and different pathogenic microorganisms were independent risk factors of adverse outcomes of PD-related peritonitis in younger patients.We recommended that patients suffering from peritonitis should timely receive standardized treatments.

关 键 词：腹膜透析 腹膜透析相关性腹膜炎 就诊时间 预后 

分 类 号：R473.5[医药卫生—护理学]