【摘要】目的 了解持续非卧床式腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)合并继发性腹膜炎的临床表现特点，以提高对此症的诊治水平。方法 对在2003年1月～2003年4月期间澳门仁伯爵综合医院肾科收治的3例CAPD患者合并继发性腹膜炎的临床资料进行回顾性分析，并以同期收治的8例CAPD相关性腹膜炎为对照组，对两组患者的年龄、CAPD时间和化验结果进行统计分析。结果 3例继发性腹膜炎患者均为女性，年龄(75.3±5.5)岁，既往无腹膜炎史。在入院时，所有患者均被误诊为CAPD相关性腹膜炎。对两例患者进行腹部X线平片检查分别可见膈下游离气体和小肠梗阻征象。治疗延误3～28天，最后诊断分别为回肠穿孔、乙状结肠缺血性坏死和绞窄性切口疝。两组患者的年龄、血红蛋白、血白细胞(WBC)、血清白蛋白、C反应蛋白(CRP)和入院时腹膜透析液WBC计数(D1)无显著性差异(P＞0.05)；继发性腹膜炎和CAPD相关性腹膜炎的不同点表现在：①CAPD时间明显长[(24.6±7.5)月 vs (10.5 ± 8.2)月，P = 0.035]；②多数患者在发病早期可见粉红色腹膜透出液；③对抗炎治疗效果差(P＜0.05)；④病死率高 (67% vs 0)。结论 CAPD患者合并继发性腹膜炎的临床表现和CAPD相关性腹膜炎有所不同，其临床误诊率和病死率高，应引起临床医生重视。

Objective We investigated the clinical features of secondary peritonitis in patients receiving continuous peritoneal dialysis (CAPD) in order to improve its diagnosis and management. Methods We retrospectively analyzed the clinical data of secondary peritonitis complicated with CAPD in 3 cases, who were admitted to Division of Nephrology, CHCSJ Hospital of Macau between January and April 2003. We also recruited 8 CAPD related peritonitis patients, who were admitted at the same period. We then statistically analyzed their age, duration of CAPD and laboratory data in the two groups. Results In the 3 patients with secondary peritonitis, they were all females with the mean age of 75.3+5.5 years. They had no history of peritonitis before admission, and had been misdiagnosed as CAPD related peritonitis. Abdominal X-ray examination in 2 cases revealed free air in sub-diaphragm area and signs of intestinal obstruction. Surgical treatment was delayed for 3 to 28 days, and finally they were diagnosed as ileum perforation, ischemic necrosis of sigmoid colon, and strangulated incision hernia. Age, hemoglobin, WBC, serum albumin, C-reactive protein, and WBC count in effluent peritoneal dialysate on admission (D1) were similar between the two groups (P>0.05). Patients with secondary peritonitis had the following features as compared with those of CAPD related peritonitis patients: ①longer duration of CAPD (24.6+7.5 months vs 10.5+8.2 months, P =0.035), ② pink effluent peritoneal dialysate found in most cases at the early stage of secondary peritonitis,③ poor response to antibiotic therapy (P <0.05), and ④ higher mortality rate (67% vs 0). Conclusion Patients with secondary peritonitis have clinical features different from those with CPAD related peritonitis. Due to the higher misdiagnosis rate and mortality rate in CAPD patients with secondary peritonitis, differential diagnosis between secondary peritonitis and CAPD related peritonitis should be carefully made in CAPD patients with peritonitis manifestations.