中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (10): 527-530.doi: 10.3969/j.issn.1671-4091.2016.10.004

• 临床研究 • 上一篇    下一篇

门诊治疗腹膜透析相关性腹膜炎的有效性研究

芦丽霞,赵慧萍,武蓓,乔婕,武向兰,门春翠,王梅   

  1. 北京大学人民医院肾内科
  • 收稿日期:2016-03-16 修回日期:2016-07-17 出版日期:2016-10-12 发布日期:2016-10-10
  • 通讯作者: 赵慧萍 huipingzhao2009@163.com E-mail:huipingzhao2009@163.com
  • 基金资助:

    本研究为北京大学人民医院研究与发展基金资助项目(研究编号：RDB2014-16)

The treatment effectiveness of peritoneal dialysis- related peritonitis in outpatient clinic

  • Received:2016-03-16 Revised:2016-07-17 Online:2016-10-12 Published:2016-10-10

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摘要： 目的探讨门诊治疗腹膜透析相关性腹膜炎的有效性。方法回顾2008 年1 月1 日～2013年12 月31 日在北京大学人民医院腹膜透析中心维持性腹膜透析患者门诊随访期间发生腹膜透析相关性腹膜炎的诊治情况。由于其他原因住院期间发生的腹膜炎不记录在内；症状重或一般状况差的腹膜炎患者收入院治疗，亦不记录在内。按照门诊治疗效果分为治愈和治疗无效。收集一般资料，记录腹膜炎的发生情况、临床转归以及化验指标。结果①6 年间共有63 名腹膜透析患者在居家治疗期间发生103次腹膜炎。其中门诊治疗80 次，住院治疗23 次，门诊治疗次数占总次数的77.7%。②门诊治疗组中，治愈75 次，无效5 次，门诊治疗有效率93.8%。③门诊治疗无效组患者就诊时腹膜透析液中白细胞数明显高于门诊治愈组(t=-2.176，P=0.033)。在病原体方面，门诊治疗无效组患者金葡菌及培养阴性腹膜炎的比例高于门诊治愈组(无效组：金葡菌20.0%，培养阴性腹膜炎60.0%；治愈组：金葡菌8.0%，培养阴性腹膜炎29.3%)，但是未见统计学差异(χ2=4.102，P= 0.392). 结论在坚持规范的腹膜炎诊疗及随访流程的前提下，门诊治疗轻症腹膜炎安全有效。在门诊治疗腹膜炎期间，对于营养状态差、就诊时腹膜透析液中白细胞数多，以及一些特殊病原体感染的腹膜炎患者，需要密切监测，必要时及时收入院进一步治疗。

关键词: 腹膜透析, 腹膜炎, 门诊治疗, 有效性

Abstract: Objectives We aimed to investigate the treatment effectiveness of peritoneal dialysis (PD)-related peritonitis in outpatient clinic through a retrospective study. Methods We reviewed all episodes of PD-related peritonitis in maintenance PD patients followed up in outpatient clinic from Jan 1, 2008 to Dec 31, 2013 in Peking University People’s Hospital. Peritonitis occurred during hospitalization were not included in this study. Patients admitted to the hospital because of severe symptoms and poor general conditions were also excluded. The effect of treatment included cured and ineffective patients. Their demographic data, episode of peritonitis, clinical outcome and laboratory indices were recorded. Results ① During six years, a total of 103 times of peritonitis occurred in the 63 PD patients during home PD, and 80 episodes (77.7%) were treated in outpatient clinic. ②Among the 80 episodes of peritonitis treated in outpatient clinic, 75 episodes were cured (93.8%), 5 were ineffective. ③Compared with the cured patients, the ineffective patients had higher dialysate leukocyte count at the beginning of follow-up in outpatient clinic (t=-2.176, P=0.033). The proportion of Staphylococcus aureus and negative bacterial culture were higher in ineffective patients than in cured patients (Staphylococcus aureus 20% and negative bacterial culture 60% in ineffective patients; Staphylococcus aureus 8.0% and negative bacterial culture 29.3% in cured patients), but without statistical significance (χ2=4.102, P=0.392). Conclusions Under the premise of standardized diagnosis, treatment, and follow-up procedures about peritonitis, outpatient treatment of mild peritonitis is safe and effective. We should pay more attention to those with poor nutrition state, more dialysate leukocytes, and the peritonitis infected with specific pathogens. If necessary, these patients should be admitted to the hospital in time for further management.

Key words: Peritoneal dialysis, Peritonitis, Outpatient treatment, Effectiveness