中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (06): 374-377.doi: 10.3969/j.issn.1671-4091.2018.06.004

• 临床研究 • 上一篇    下一篇

抗炎联合低浓度碘伏封管治疗难治性腹膜炎的初步探索

姜鸿1,贾依娜西·阿扎提1,吴亚琴1,谭一香1   

  1. 1. 新疆维吾尔自治区人民医院肾病科
  • 收稿日期:2018-01-10 修回日期:2018-03-29 出版日期:2018-06-12 发布日期:2018-06-20
  • 通讯作者: 姜鸿 jangh-yt@163.com E-mail:jangh-yt@163.com

Investigation of systemic antibiotics therapy combined with blocking dialysis catheters using low concentration of povidone-iodine for the treatment of refractory peritoneal dialysis-related peritonitis

  • Received:2018-01-10 Revised:2018-03-29 Online:2018-06-12 Published:2018-06-20

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摘要： 【摘要】目的初步探索抗炎联合低浓度碘伏封管治疗难治性腹膜炎的可行性。方法回顾分析新疆自治区人民医院近2 年内诊断明确难治性腹膜炎，符合指南拔管条件，但拒绝拔管治疗的腹膜透析患者7 例。在抗生素治疗的基础上，腹腔内灌入整袋透析液，然后以0.9%生理盐水加碘伏按1:1 比例配置10 毫升，从外接短管入口处缓慢推入封管，30min 后引流出整袋透析液，并更换外接短管，隔日1 次进行，共3 次，后2 次不再更换外接短管，继续抗炎，总抗菌疗程为14～21 天。结果腹膜透析液培养阳性检出率85.71%，分别为大肠埃希菌3 例；麻疹孪古球菌1 例；金黄色葡萄球菌1 例；表皮葡萄球菌1 例；结果细菌培养阴性1 例。患者经过抗生素联合碘伏腹腔冲洗治疗，4 天后5 例患者腹膜透析液培养转阴，1 周后所有患者腹膜透析液白细胞总数[5.64(2.18，2.05)×109/L 比0.25(0.20，0.29)×109/L，Z=-2.666,P=0.008]、血清白细胞数目[10.50(9.73，13.82) × 109/L 比6.82(5.69，10.72) × 109/L，Z=- 2.108,P=0.035]、中性粒细胞百分比[89.90(77.20，92.50)%，69.80(62.10，85.70)%，Z=-2.108,P=0.035]以及C 反应蛋白[85.30(65.22，105.89)mg/L 比34.30(31.36，46.65)mg/L，Z=-2.364,P=0.018]明显下降，治疗结
束5 例临床治愈出院，其余2 例症状未改善予以拔管。结论通过抗炎联合低浓度碘伏封管治疗难治性腹膜炎属于经济实惠的新型疗法，有一定疗效，值得进一步在经济落后、地处偏远、血液透析困难的地区推广研究。

关键词: 腹膜透析, 难治性腹膜炎, 碘伏封管, 治疗

Abstract: 【Abstract】Objective To evaluate the effect of systemic antibiotics therapy combined with blocking dialysis catheters with low concentration of povidone-iodine (PVP-I) on refractory peritoneal dialysis (PD)-related peritonitis. Methods We retrospectively analyzed 7 patients with refractory PD-related peritonitis treated in the recent 2 years. Their dialysis catheters were planned to take off according to the latest ISPD recommendations, but they refused to do this. In addition to systemic antibiotics therapy, low concentration of PVP-I (1:1 of PVP-I and normal saline, 10ml) was gradually injected into the external short tube to block the catheter after infusion of 2000ml of peritoneal dialysate. After 30 minutes, the infused dialysate was drained out, and the external short tube was changed. This manipulation performed every other day for 3 times but without change of the external short tube anymore. The systemic antibiotics therapy lasted 14～21 days. Results Bacterial culture for peritoneal dialysate was positive in 6 of the 7 patients (85.71%). The bacteria detected included E. coli 3 cases, Gemella mobillorum one case, staphylococcus aureus one case and staphylococcus epidermidis one case. After the treatment for 4 days, bacterial culture became negative in 5 cases. After the treatment for one week, WBC in peritoneal dialysate [5.64 (2.18, 2.05)×109/L vs. 0.25 (0.20, 0.29)×109/L, Z=-2.666, P=0.008], WBC in blood [10.50 (9.73, 13.82)×109/L vs. 6.82 (5.69, 10.72)×109/L, Z=-2.108, P=0.035], neutrophil percentage [89.90 (77.20, 92.50)% vs. 69.80 (62.10, 85.70)% , Z=- 2.108, P=0.035] and CRP [85.30 (65.22, 105.89)mg/L vs. 34.30 (31.36, 46.65)mg/L, Z=-2.364, P=0.018] decreased significantly. At the end of the treatment, the peritonitis cured and the patients discharged from the hospital in 5 cases, and the catheters had to be taken off in 2 cases. Conclusion Systemic antibiotics therapy combined with low concentrations of PVP-I to block the catheters was effective for the treatment of refractory PD-related peritonitis. This treatment protocol is especially useful for the patients living far from big cities, in underdeveloped areas or unavailable access to hemodialysis.

Key words: Peritoneal dialysis,  Refractory peritoneal dialysis-related peritonitis, Blocking catheter with povidone-iodine, Treatment