中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (02): 73-77.doi: 10.3969/j.issn.1671-4091.2018.02.001

• 临床研究 •    下一篇

腹膜透析相关性腹膜炎临床特点与危险因素分析

马东红1,吕玉敏1,刘云1,师晶晶1,郭明好1   

  1. 1. 新乡医学院第一附属医院肾病科
  • 收稿日期:2017-07-05 修回日期:2017-12-04 出版日期:2018-02-12 发布日期:2018-02-12
  • 通讯作者: 马东红 dhmasxmu@163.com E-mail:dhmasxmu@163.com

Clinical characteristics and risk factors of peritoneal dialysis-related peritonitis

  • Received:2017-07-05 Revised:2017-12-04 Online:2018-02-12 Published:2018-02-12
  • Contact: Dong-Hong dongMA E-mail:dhmasxmu@163.com

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摘要： 目的探讨腹膜透析相关性腹膜炎发生的原因、特点及相关危险因素，为腹膜炎的防治提供依据。方法回顾性分析2015 年6 月～2016 年12 月新乡医学院第一附属医院肾内科规律随访的腹膜透析相关性腹膜炎患者34 例，同时收集同期未发生腹膜炎的患者83 例，分析腹膜炎发生的原因、特点及危险因素。结果① 腹膜炎发生的原因主要是肠道感染12 例(35.29% ) 和换液操作不规范9 例(26.47%)。②腹透液培养结果显示革兰阳性球菌20 例(58.82%)，革兰阴性杆菌13 例(38.24%)，真菌1例(2.94%)。其中革兰阳性菌以表皮葡萄球菌、金黄色葡萄球菌为主，而革兰阴性菌主要以大肠埃希菌为主。革兰阳性球菌对万古霉素、替考拉宁、利奈唑胺敏感，对头孢唑林敏感性70%；革兰阴性杆菌对亚胺培南、美罗培南敏感，对头孢他啶敏感性为80%。③多因素logistic 回归分析显示，腹膜透析相关性腹膜炎发生的独立危险因素有3 个：透析龄[OR=1.106，95%CI(1.027，1.192)，P=0.008]、总蛋白水平[OR=20.720，95% CI(1.954，219.728)，P=0.012] 和血钙水平[OR=113.847，95% CI(9.012，1438.214)，P<0.001]。④每例患者入院后即给予头孢唑林联合头孢他啶治疗，然后根据药敏结果调整治疗方案，总治愈率为91.18%。结论①本中心腹膜透析相关性腹膜炎发生的主要原因为腹泻和操作不规范；②透析龄长、总蛋白和血钙水平降低是腹膜透析相关性腹膜炎发生的独立危险因素；③本中心腹膜炎患者多数预后良好，极少数需要拔管才可治愈。

关键词: 腹膜透析相关性腹膜炎, 危险因素

Abstract: Objective To investigate the causes, characteristics and risk factors of peritoneal dialysis(PD)-related peritonitis. Methods We recruited 34 cases with PD-related peritonitis treated in the First Affiliated Hospital of Xinxiang Medical College from Jun. 2015 to Dec. 2016 as the observation group, and 83 PD cases without peritonitis as the control group. The causes, characteristics and risk factors of peritonitis were analyzed. Results ①The main causes of peritonitis were intestinal infection (12 cases, 35.29%) and wrong operation of dialysate change (9 cases, 26.47%). ②The culture of peritoneal fluid found Gram-positive cocci in 20 cases (58.82%), Gram-negative bacilli in 13 cases (38.24%), and fungi in one case (2.94%). Grampositive bacteria were mainly epidermal staphylococcus and staphylococcus aureus, while Gram-negative baclli were mainly E. coli. Gram-positive cocci were sensitive to vancomycin, teicoplanin, and linazolamide in all cases, and the sensitivity rate to cefazolin was 70%. Gram-negative bacteria were sensitive to imipenem and meropenem in all cases, and the sensitivity rate to ceftazidime was 80%. ③Multivariate logistic regression analysis showed that dialysis duration (OR=1.106, 95% CI 1.027~1.192, P=0.008), plasma protein level (OR=20.720, 95% CI 1.954~219.728, P=0.012) and serum calcium level (OR=113.847, 95% CI 9.012~1438.214, P<0.001) were the independent risk factors for PD-related peritonitis. ④cefazolin plus ceftazidime were used as the initial treatment in all cases, and then the therapeutic schedule was adjusted based on the culture results of peritoneal fluid. Thirty-one cases (91.18%) recovered. Conclusions The main causes of PDrelated peritonitis were intestinal infection and wrong operation of dialysate changes. Longer dialysis duration, lower plasma protein and serum calcium were the independent risk factors for PD- related peritonitis. Most patients in our center had a better prognosis, and only a few patients had to take out the Tenkhoff catheter.

Key words: peritoneal dialysis-related peritonitis, risk factors