间歇性尿激酶封管联合万古霉素治疗表皮葡萄球菌复发性腹膜炎疗效观察  

作　　者：朱虹[1] 雷文晖[1] 孙晓莉[1] 朱剑霞[1] 毛明锋[1] 

机构地区：[1]浙江省丽水市中心医院,323000

出　　处：《浙江临床医学》2020年第11期1588-1589,共2页Zhejiang Clinical Medical Journal

基　　金：浙江省丽水市科技局项目(2016GYX07、2019SJZC41)。

摘　　要：目的探讨表皮葡萄球菌复发性腹膜炎的原因,观察间歇性尿激酶封管联合万古霉素治疗表皮葡萄球菌复发性腹膜炎的疗效>方法2010年1月至2019年5月表皮葡萄球菌致复发性腹膜炎患者7例,分别采用更换透析导管和药物治疗;3例予以更换透析导管..4例拒绝换管的患者根据药敏给予尿激酶5万U封管联合万古霉素针1.0治疗,给药1次/5 d,完成5〜7个周期后,改为1次/15 d,使用2次,再1次/月连续应用3个月,然后停药,观察治疗效果及副作用,结果3例更换透析导管后,随访51个月未再发生表皮葡萄球菌性腹膜炎。4例采用间歇性尿激酶封管联合万古霉素治疗者平均随访31个月均未再发表皮葡萄球菌相关腹膜炎。其中1例患者成功接受肾移植,1例患者因反复发生胆结石诱发腹膜炎转血液透析。2例仍继续腹膜透析治疗使用间歇性尿激酶封管联合万古霉素治疗者未发生明显腹痛、腹腔出血等并发症结论表皮葡萄球菌腹膜炎的复发提示导管的腹内段有生物膜形成,更换腹膜透析管是最好的治疗方法,间歇性尿激酶封管联合万古霉素治疗表皮葡萄球菌复发性腹膜炎有效。Objective To investigate the causes of recurent peritonitis infected by Staphylococcus epidermidis and to observe the eficacy of intermittent urokinase closure combined with vancomycin in the treatment of recurrent peritonitis.Methods From January 2010 to May 2019,7 patients with recurrent peritonitis caused by Staphylococcus epidermidis were treated with dialysis catheter replacement and antibioic therapy.Among them,3 case was replced with dialysis catheter.Four patients who refused to replace the peritoneal dialysis catheter were treated with"Urokinase 50,000 units sealing catheter combined with vancomycin injection 1.0"according to drug sensitivity.They were given once every five days.Afer completing seven cycles,they were given once a half month for one month,then converted to once a month for three months.The therapeutic efect and side ffects were observed.Results Three cases of staphylococcal peritonitis did not recur again afer 51 months of follow-up after replacing the dialysis catheter.Four patients treated with intermittent urokinase sealing combined with vancomycin were followed u for an average of 31 months without recurrent staphylococcal peritonitis.One patient received a sucessful kidney transplanation and one patient was conerted to hemodialysis for recurrent gllstone-induced peritonitis.Peritoneal dialysis was continued in 2 case.No obvious abdominal pain,abdominal bleeding and other complications occurred in patients treated with intrmittent urokinase sealing combined with vancomycin.Conclusion The recurrence of Staphylococcus epidermidis peritonitis indicates the formation of biofilm in the intra-abdominal segment of the catheter.Replacing the peritoneal dialysis catheter is the best treatment.This study suggests that intermittent closure of urokinase combined with vancomycin is efective in the treatment of rcurrent peritonitis of Staphylococcus epidermidis without obvious side efects.It provides a new altermative treatment for recurrent peritonitis.

关 键 词：复发性腹膜炎 腹膜透析 表皮葡萄球菌 

分 类 号：R65[医药卫生—外科学]