假单胞菌腹膜透析相关性腹膜炎的临床特点与治疗转归  

Clinical Characteristics and Treatment Outcome of Pseudomonas Peritoneal Dialysis-associated Peritonitis

作　　者：倪册 杨立明[2] 朱学研[3] 张晓暄 周文华[1] 谢舜昀 于梦园 庄小花[1] 罗萍[1] 崔文鹏[1] NI Ce;YANG Liming;ZHU Xueyan;ZHANG Xiaoxuan;ZHOU Wenhua;XIE Shunyun;YU Mengyuan;ZHUANG Xiaohua;LUO Ping;CUI Wenpeng(Department of Nephrology,the Second Hospital of Jilin University,Changchun 130041,China;Department of Nephrology,the Easrern Division of the First Hospital of Jilin University,Changchun 130031,China;Department of Nephrology,Jilin Central Hospital,Jilin,Jilin 132011,China;Department of Nephrology,Jilin First Automobile Work General Hospital,Changchun 130011,China)

机构地区：[1]吉林大学第二医院肾病内科,长春130041 [2]吉林大学第一医院二部肾病内科,长春130031 [3]吉林市中心医院肾病内科,吉林吉林132011 [4]吉林省一汽总医院肾病内科,长春130011

出　　处：《中国医学科学院学报》2022年第1期45-52,共8页Acta Academiae Medicinae Sinicae

基　　金：吉林省卫生健康委员会项目(2017Q024、2018FP031)。

摘　　要：目的探讨假单胞菌腹膜透析相关性腹膜炎(PsP)的临床特点及治疗方案。方法回顾性收集2015年至2019年在吉林省4家三甲医院就诊的腹膜透析患者的临床资料,并将腹膜透析相关性腹膜炎(PDAP)患者按照病原学分为PsP组和非PsP组。计算PsP的发生率,对比两组患者的临床特点和治疗结果。采用Kaplan-Meier法绘制生存曲线,应用Cox回归法分析影响PsP技术失败的危险因素。总结铜绿假单胞菌PDAP的治疗方案和PsP药敏情况。结果共纳入临床资料完整的腹膜透析患者1530例,其中439例患者发生664次PDAP。PsP发生率为0.007次/人年。与非PsP组相比,PsP组难治性腹膜炎比例高(41.38%比19.69%,P=0.005)、治愈率低(55.17%比80.79%,P=0.001)、拔管率高(24.14%比7.09%,P=0.003)。PsP组的技术生存率低于非PsP组(P<0.001)。多因素Cox回归分析显示铜绿假单胞菌是PsP患者技术失败的独立危险因素(HR=9.020,95%CI=1.141~71.279,P=0.037)。假单胞菌对阿米卡星、美罗培南、哌拉西林他唑巴坦敏感性较高,对复方新诺明、头孢唑林、氨苄西林的耐药性较高。结论PsP较非PsP的治疗效果差,铜绿假单胞菌是影响PsP技术失败的主要原因。Objective To explore the clinical characteristics and treatment of Pseudomonas peritoneal dialysis-associated peritonitis(PsP).Methods The data of patients receiving peritoneal dialysis in four tertiary hospitals in Jilin province from 2015 to 2019 were retrospectively analyzed.According to the etiological classification,the patients with peritoneal dialysis-associated peritonitis(PDAP)were classified into PsP group and non-PsP group.The incidence of PsP was calculated,and the clinical characteristics and treatment outcomes of the two groups were compared.Kaplan-Meier method was used to draw the survival curve,and Cox regression was performed to analyze the risk factors affecting the technical failure of PsP.The treatment options of Pseudomonas aeruginosa-caused PDAP and the drug sensitivity of PsP were summarized.Results A total of 1530 peritoneal dialysis patients with complete data were included in this study,among which 439 patients had 664 times of PDAP.The incidence of PsP was 0.007 episodes/patient-year.PsP group had higher proportion of refractory peritonitis(41.38%vs.19.69%,P=0.005),lower cure rate(55.17%vs.80.79%,P=0.001),and higher extubation rate(24.14%vs.7.09%,P=0.003)than non-PsP group.The technical survival rate of PsP group was lower than that of non-PsP group(P<0.001).Multivariate Cox regression analysis showed that Pseudomonas aeruginosa was an independent risk factor for technical failure in patients with PsP(HR=9.020,95%CI=1.141-71.279,P=0.037).Pseudomonas was highly sensitive to amikacin,meropenem,and piperacillin-tazobactam while highly resistant to compound sulfamethoxazole,cefazolin,and ampicillin.Conclusion The treatment outcome of PsP is worse than that of non-PsP,and Pseudomonas aeruginosa is an independent risk factor for technical failure of PsP.

关 键 词：假单胞菌属 铜绿假单胞菌 腹膜透析 腹膜炎 

分 类 号：R572.2[医药卫生—消化系统]