中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (12): 713-717.doi: 10.3969/j.issn.1671-4091.2015.12.004

• 临床研究 • 上一篇    下一篇

腹膜透析患者首发腹膜炎的临床特征与拔管风险

陈再强,黄晓彦,梁伟,熊子波,廖玉梅,熊祖应   

  1. 北京大学深圳医院肾内科(陈再强为汕头大学医学院研究生)
  • 收稿日期:2015-02-04 修回日期:2015-09-28 出版日期:2015-12-12 发布日期:2015-12-12
  • 通讯作者: 黄晓彦 xiaoyan.huang@kise E-mail:469108316@qq.com

Clinical characteristics of the first episode of peritonitis and the risks of extubation in peritoneal dialysis patients

  • Received:2015-02-04 Revised:2015-09-28 Online:2015-12-12 Published:2015-12-12

RichHTML

0

PDF

188

摘要： 目的探讨腹膜透析患者首发腹膜炎的诱因、临床特征、致病菌及转归情况，为临床防治腹膜炎提供参考。方法本中心共有273 例腹膜透析患者，本研究选择2002 年8 月至2013 年10 月所有在本院住院的首次发生腹膜炎患者67 例，分析首发腹膜炎患者(发病组)与未发生腹膜炎患者(未发病组)的临床指标；根据首次发生腹膜炎患者的临床转归分为治愈组和拔管组，比较两组临床、实验室指标及腹膜炎病因等，并采用logistic 回归分析拔管危险因素。所有患者确诊腹膜炎后立即留取标本培养并经验性抗感染治疗，再根据临床表现、病原微生物培养及药敏结果调整使用敏感抗生素；收集人口学资料、基础肾脏病、透析龄、诱因、临床指标、透出液常规、涂片和细菌培养结果、治疗方法、治疗时间、治疗效果、临床转归等。结果首发腹膜炎患者存在年龄偏大[发病组均龄 (53.1 ± 14.9)岁 vs. 未发病组均龄(46.6±14.3)岁]、低蛋白血症[白蛋白:发病时(27.4±4.0)g/L vs.未发病时(32.5±5.7)g/L]和操作不当(53.7%)情况。拔管组有更长透析龄[24(11.4,42)月vs.13.2(4.8,18.84)月，P =0.020]，更严重低蛋白血症[(24.5±5.8)g/L vs.(29.3±4.1)g/L，t=-4.088，P =0.000]，而且拔管组腹膜炎病因以非操作相关为主(61% vs.36%，χ2=13.075,P =0.011)、非G+菌感染为主(74% vs.41%，P =0.000)。结论首发腹膜炎患者存在较高年龄、营养欠佳、非规范化操作等情况，而长透析龄、严重低蛋白血症、非操作相关、非G+菌感染的患者有较高的拔管风险。

关键词: 连续性不卧床腹膜透析, 腹膜炎, 拔管风险, 低蛋白血症, 透析龄

Abstract: Objectives For better prevention and treatment of peritonitis in patients with continuous ambulatory peritoneal dialysis (CAPD), we investigated the pathogens, inducing factors, clinical features and prognosis of the first episode of peritonitis in these patients. Methods A total of 67 patients experienced the first episode of peritonitis from Aug. 2002 to Oct. 2013 were recruited and divided into 2 groups based on clinical outcomes. Forty-one patients cured and 26 patients were treated with extubation. All patients were empirically treated with antibiotics after diagnosis. Antibiotic regimen was then adjusted according to the results of
culture and drug sensitivity tests. Demographic data, primary kidney disease, dialysis age, inducing factors, clinical indexes, bacterial culture results, therapies and clinical outcomes were collected for analyses. Results Patients with peritonitis were older than the controls (53.1±14.9 yr vs. 46.6±14.3 yr). Hypoproteinemia aggravated after the onset of peritonitis (ALB: 27.4±4.0 g/L vs. 32.5±5.7 g/L) . A higher incidence of inappropriate operation (53.7%) was found in patients with peritonitis. Extubation patients had longer dialysis age [24(11.4, 42) months vs. 13.2 (4.8, 18.84) months, P=0.020] and more severe hypoproteinemia (24.5±5.8 g/L vs. 29.3± 4.1 g/L, P=0.000) than the cured patients. In most extubation patients, the extubation was unrelated to mis-operation (61%vs. 36%, P=0.01) and the pathogens were non-Gram+ bacteria (74%vs. 41%, P＜0.001) as compared with the cured patients. Conclusions The first episode of peritonitis is related to older age, malnutrition, and inappropriate operation. Patients with longer dialysis age, severe hypoproteinemia, non-Gram+bacterial infection, and less mis-operation tend to have a higher risk of extubation.

Key words: Continuous ambulatory peritoneal dialysis, Peritonitis, risk of exbutation, hypoproteinemia, dialysis age