腹膜透析相关性腹膜炎的诊治进展  

Recent advances in the diagnosis and treatment of peritoneal dialysis-associated peritonitis

作　　者：侯世会 杨杰 何娅妮 陈客宏 Hou Shi-hui;Yang Jie;He Ya-ni;Chen Ke-hong(Department of Nephrology,Daping Hospital,Army Military Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院肾内科,重庆400042

出　　处：《临床肾脏病杂志》2022年第9期779-783,共5页Journal Of Clinical Nephrology

基　　金：重庆市技术创新项目(2022YSZX-JCX0007CSTB,cstc2019jscx-gksbX0024);大坪医院教育训练创新能力培养计划(2019CXJXC005)。

摘　　要：腹膜透析相关性腹膜炎是腹膜透析的常见并发症,具有较高的发病率和病死率。腹膜炎早期诊断、及时准确的抗感染治疗是提高腹膜炎治疗成功率的关键。本文从腹膜炎的诊断、治疗及预防等基本问题出发,结合国际研究前沿进展,对腹膜炎治疗的时机、抗生素的选择及给药方式、腹膜透析管的拔除进行综述,并且介绍一些新的有助于快速检测腹膜炎病原微生物的技术手段,如细菌来源的脱氧核糖核酸片段的聚合酶链反应、基质辅助激光解吸电离飞行时间质谱分析法等。也对难治性腹膜炎的原因进行总结分析,建议深入腹膜透析时抗生素的药代动力学和药效学相关研究,并在腹膜炎治疗过程中监测不同抗生素的浓度,实现更加精准的抗感染治疗。本综述旨在为下一步的腹膜炎研究提供方向和建议,以期提高腹膜炎治疗的成功率。Peritonitis associated with peritoneal dialysis is a common complication of peritoneal dialysis with a high level of morbidity and mortality.Early diagnosis and timely and accurate anti-infective regimen are vital for boosting the success rate of peritonitis treatment.Based upon the diagnosis,treat⁃ment and prevention of peritonitis,this review summarized the timing of peritonitis treatment,the choice of antibiotics,the mode of antibiotics administration and the removal of peritoneal dialysis tubes.Some novel techniques,such as polymerase chain reaction(PCR)and matrix-assisted laser desorption ioniza⁃tion time of flight mass spectrometry,were introduced for rapid detection of pathogenic microorganisms.The causes of refractory peritonitis and the pharmacokinetics and pharmacodynamics of antibiotics during peritoneal dialysis were also discussed.Monitoring the concentrations of different antibiotics may enable more accurate anti-infections.The review was intended to provide directions and suggestions for further researches on peritonitis for lowering the incidence of peritonitis and improving the success rate of treat⁃ment.

关 键 词：腹膜透析 腹膜透析相关性腹膜炎 治疗 预防 

分 类 号：R692.5[医药卫生—泌尿科学]