革兰阴性菌致腹膜透析相关性腹膜炎患者预后及危险因素  

Prognosis and Risk Factors of Patients with CAPD-related Peritonitis Caused by Gram-Negative Bacteria

作　　者：李洋[1,2] 王亚芬[1] 吴玉梅 LI Yang;WANG Ya-fen;WU Yu-mei(Department of Nephrology, Affiliated Hospital of Jining Medical College, Jining, Shandong 272000, China;School of Medicine and Life Sciences, Shandong Academy of Medical Sciences, Jinan 250000, China;Department of Nephrology, the First People's Hospital of Jining, Jining, Shandong 272011, China)

机构地区：[1]济宁医学院附属医院肾内二科,山东济宁272000 [2]济南大学山东省医学科学院医学与生命科学学院,济南250000 [3]济宁市第一人民医院肾内科,山东济宁272011

出　　处：《临床误诊误治》2019年第6期76-80,共5页Clinical Misdiagnosis & Mistherapy

基　　金：山东省自然科学基金资助项目(ZR2014HL095)

摘　　要：目的:探讨革兰阴性菌致腹膜透析相关性腹膜炎患者预后及其危险因素。方法:选取2011年1月-2017年12月我院收治的82例革兰阴性菌致腹膜透析相关性腹膜炎作为研究对象,记录患者的临床资料,分析影响预后的相关因素。结果:本研究完全治愈51.22%(42/82),复发、再发或重现26.83%(22/82),拔管或死亡21.95%(18/82)。不同预后患者年龄、体质量指数及透析时间比较差异具有统计学意义(P<0.05)。经非条件单因素logistic回归分析显示,透析时间过长、既往有心脏病和糖尿病、体质量指数过低、年龄过大、血红蛋白和白蛋白水平过低及钙磷乘积和C-反应蛋白水平过高的革兰阴性菌致腹膜透析相关性腹膜炎患者拔管或死亡的发生率均显著升高(P<0.05)。经非条件多因素logistic回归分析显示,高龄、既往糖尿病病史、白蛋白和血红蛋白水平过低及C-反应蛋白水平过高是革兰阴性菌致腹膜透析相关性腹膜炎患者拔管或死亡的独立危险因素(P<0.05)。结论:高龄、既往糖尿病病史、白蛋白和血红蛋白水平过低及C-反应蛋白水平过高是革兰阴性菌致腹膜透析相关性腹膜炎患者拔管或死亡的独立危险因素,临床应予以重视。Objective To investigate the prognosis and risk factors of patients with CAPD-related peritonitis caused by gram-negative bacteria. Methods Eighty-two patients with CAPD-related peritonitis caused by gram-negative bacteria admitted to our hospital from January 2011 to December 2017 were selected as study objects. Clinical data of the patients were recorded. The related factors affecting prognosis were analyzed. Results In this study, 51.22%(42/82) was completely cured, the recurrence rate was 26.83%(22/82), and the proportion of extubation or death was 21.95%(18/82). The differences in age, body mass index and duration of dialysis of patients with different prognosis were statistically significant ( P <0.05). Univariate unconditional logistic regression analysis showed that incidence of extubation or death was significantly increased in patients with CAPD-related peritonitis caused by gram-negative bacteria who had exceedingly long duration of dialysis, exceedingly low BMI and hemoglobin and albumin levels, and exceedingly high calcium-phosphorus product and CRP level, who was too old and who had heart disease and diabetes ( P <0.05). Multivariate unconditional logistic regression analysis showed that advanced age, previous history of diabetes, exceedingly low albumin and hemoglobin levels, and exceedingly high CRP levels were independent risk factors for extubation or death in patients with CAPD-related peritonitis caused by gram-negative bacteria ( P <0.05). Conclusion Advanced age, previous history of diabetes, exceedingly low albumin and hemoglobin levels, and exceedingly high CRP levels were independent risk factors for extubation or death in patients with CAPD-related peritonitis caused by gram-negative bacteria, to which clinicians should pay more attention.

关 键 词：腹膜炎 腹膜透析 革兰氏阴性菌 预后 危险因素 

分 类 号：R572.2[医药卫生—消化系统]