摘要
目的探讨腹膜透析(PD)相关性腹膜炎的发生原因及影响因素。方法回顾PD相关性腹膜炎患者51例(75例次)的临床资料,分析腹膜炎的发生原因、危险因素、致病菌及其耐药性。结果引起腹膜炎的主要原因是换液操作不规范和肠道感染。高超敏C反应蛋白及低尿酸是PD相关性腹膜炎发生的独立危险因素(P<0.05)。PD液培养阳性46例次,共分离出病原菌49株,包括革兰阳性菌33株、革兰阴性菌15株、真菌1株。革兰阳性菌对氨苄青霉素、万古霉素、替考拉宁和利奈唑胺耐药率较低;革兰阴性菌对亚胺培南和头孢吡肟耐药率较低。1例患者死亡,9例患者拔管,其余均治愈。结论加强PD换液的无菌操作、及时治疗腹泻和便秘、控制微炎症状态、避免尿酸过度减少、合理选择抗生素是防治PD相关性腹膜炎的有效方法。
Objective To investigate the causes and risk factors of peritoneal dialysis（PD）- associated peritonitis. Methods The data of 51 patients with PD-associated peritonitis were retrospectively studied. The causes, risk factors, pathogenic bacteria and drug resistance of peritonitis were analyzed. Results The primary causes of PD-assoeiated peritonitis were nonstandard operating steps and intestinal infection. The higher level of high sensitive C-reactive protein（hsCRP） and lower level of urea acid（UA） were the independent risk factors for PI）-associated peritonitis（P〈0. 05）. The culture results of PD fluid showed that 46 cases were positive and 49 strains of pathogenic bacteria were isolated, which included 33 strains of Gram-positive bacteria, ]5 strains of Gram-negative bacteria and 1 strain of fungus. The lower rates of drug resistance against Gram-positive bacteria were ampieillin, vaneomycin, teicoplanin and linezolid, while which against Gram-negative bacteria were imipenem and eefepime. Of 51 patients with PD-associated peritonitis, 1 case was dead, 9 cases were extubated and the others were cured. Conclusion Strengthening sterile operation of PD fluid, timely treating diarrhea and constipation, controlling micro-inflammatory state, avoiding excessive decrease of IdA and properly choosing antibiotics are the effective methods for the prevention and treatment of PD-assoeiated peritonitis.
出处
《江苏医药》
CAS
2016年第16期1801-1805,共5页
Jiangsu Medical Journal
关键词
腹膜透析
腹膜炎
致病菌
耐药性
Peritoneal dialysis
Peritonitis
Pathogenic bacteria
Drug resistance
