复发性、再发性和重现性腹膜透析相关性腹膜炎的临床特征分析

Clinical characteristics of relapsing,recurrent and repeated peritonitis relating to peritoneal dialysis

目的了解复发性、再发性和重现性腹膜透析相关性腹膜炎的临床特征,探索3种类型腹膜炎发生的致病菌、临床疗效及转归的异同点。方法回顾性研究2005年1月至2009年12月海口市人民医院腹膜透析相关性腹膜炎患者116例,分为复发组、再发组、重现组和单发组,比较各组患者的一般状况、致病菌和临床疗效及转归。结果复发组患者的年龄明显较其他3组轻。复发性和重现性腹膜炎的主要致病菌为凝固酶阴性葡萄球菌,而再发性腹膜炎为革兰阴性菌为主。再发组患者分别与复发组、重现组和单发组比较,治疗的初次应答率(分别为66.67%、88.37%、80.65%和86.67%)和完全缓解率(分别为41.67%、62.79%、67.74%和73.33%)明显低于其他各组,而死亡率明显增高(分别为16.67%、6.98%、9.68%和6.67%)。结论复发性、再发性和重现性腹膜炎的致病菌存在差异,且具有不同的临床疗效和转归。再发性腹膜炎具有治疗初次应答率低、拔管率高和死亡率高的特点,在临床上应引起重视。

Objective To identify the clinical characteristics of relapsing,recurrent and repeated peritoneal dialysis-related peritonitis.Methods A retrospective analysis was conducted in the 116 peritonitis patients undergoing peritoneal dialysis（PD） from January 2005 to December 2009 in this hospital.They were divided into four groups：relapsing group,recurrent group,repeated group and single group.Clinical data,pathogenic bacteria and clinical outcomes of the four groups were compared.Results The relapsing and repeat peritonitis were usually caused by coagulase negative staphylococcus species,whereas recurrent peritonitis was often caused by Gramnegative organisms.In the relapsing,recurrent,repeated and single groups,the response rate to therapy was 88. 37%,66.67%,80.65%and 86.67%,respectively,the complete cure rate was 62.79%,41.67%,67.74%and 73. 33%,respectively,and the mortality rate was 6.98%,16.67%,9.68%and 6.67%,respectively.Therefore,patients in recurrent group had a lower response rate to therapy,lower complete cure rate and higher mortality rate. Conclusions Relapsing,recurrent and repeated peritonitis were of distinct clinical significances.Recurrent peritonitis had lower rate of primary response to therapy,increased rate of catheter extubation and higher rate of mortality.Clinically,more attention should be paid to the recurrent peritonitis in PD-related peritonitis.