腹膜透析相关性腹膜炎的病因分析及防治措施

Peritoneal dialysis-related peritonitis cause analysis and prevention measures

目的分析腹膜透析相关性腹膜炎的病因,以期探讨如何有效地预防与治疗。方法回顾性分析135例腹膜透析患者感染腹膜炎的可能原因,并分析腹膜炎的致病菌及其药敏结果。结果连续性不卧床腹膜透析(CAPD)患者共计32例(23.7%)出现腹膜炎,其中,男性18例(13.3%),女性14例(10.4%);经分析,32例腹膜炎患者中15例(46.9%)因操作过程中未严格洗手及违规操作等导致;其次,腹泻导致7例(21.9%),腹膜透析液污染4例(12.5%),其他原因6例(18.7%);32例CAPD腹膜炎患者中,共有19例(59.4%)细菌培养阳性,其中革兰阳性球菌9例(47.4%),革兰阴性杆菌7例(36.8%),真菌3例(15.8%)。结论营养状况好、初中以上文化程度、家居环境较好的患者腹膜炎发生率低。因此,对透析患者进行鼓励培训和加强护理管理非常重要,糖尿病患者控制好血糖水平可使腹膜炎发生率相似于非糖尿病患者。腹膜炎的致病菌以革兰阳性球菌为主,其中大部分对头孢唑林素敏感,革兰阴性杆菌对哌拉西林及庆大霉素耐药率较高。

Objective Analysis of peritoneal dialysis-related peritonitis causes, in order to explore how effective prevention and treatment. Methods Retrospect 135 cases of peritonitis in peritoneal dialysis patients infected with the possible causes, and analysis of pathogens and their susceptibility results peritonitis. Results There were total of 32 patients (23.7%) with peritonitis, among them, male in 18 cases (13.3%), female in 14 cases (10.4%);After the analysis, there were 15 cases (46.9%) caused by the operation process which was not strictly hands and illegal operations;secondly, 7 cases of diarrhea (21.9%), 4 cases of peritoneal dialysis lfuid contamination (12.5%), 6 cases of other causes (18.7%);32 cases of CAPD peritonitis patients, there were 19 cases (59.4%) culture positive, including 9 cases with gram positive cocci (47.4%), gram negative bacilli in 7 cases (36.8%), 3 cases of fungus. Conclusion Good nutritional status, secondary or higher education, a better home environment low incidence of patients with peritonitis. Accordingly, patients on dialysis training and management is very important. Peritonitis pathogenic Gram-positive ball Yin Yin based, most of cefazolin Lin Sumin sense of Gram-negative bacilli to piperacillin and gentamicin resistance is higher.