维持性腹膜透析患者并发真菌性腹膜炎23例临床分析

The clinical analysis of 23 peritoneal dialysis patients with fungal peritonitis

目的对维持性腹膜透析患者并发真菌性腹膜炎的临床资料进行回顾性分析,以提高对真菌性腹膜炎的治疗水平。方法选择2005年1月～2010年12月在我院住院并诊断为真菌性腹膜炎的腹膜透析患者,记录并分析所有患者的一般资料、病史、临床症状、治疗方法及转归。结果维持性腹膜透析患者并发真菌性腹膜炎(FP)者23例,糖尿病状态3例(13.0%)。FP发生前4周使用抗生素者19例(83.6%),使用免疫抑制剂1例(4.3%),9例(39.1%)患者因疼痛剧烈使用了镇痛剂。透析液培养结果为白色念珠菌18例(78%)。4例保管抗真菌治疗并继续腹膜透析,治愈2例;20例(87%)拔管改作血液透析;死亡2例(8.7%)。结论对真菌性腹膜炎提倡立即拔管,但在特殊情况下可予以适当考虑保留腹膜透析管。本研究为单中心回顾性研究,需设计更好的前瞻性研究探讨维持性腹膜透析患者并发真菌性腹膜炎的治疗细节。

Objective To evaluate the clinical manifestations, treatment and prognosis in peritoneal dialysis patients with fungal peritonitis （FP）. Methods The clinical data of 23 peritoneal dialysis （PD） patients diagnosed as FP and treated in our hospital from January 2005 to December 2010 were retrospectively analyzed. Results Among 23 patients ,9 （39. 1% ） used analgesics due to dramat- ic abdominal pain. The PD cuhure in eighteen （78%） patients with FP grew Candida albicans. Among 4 patients who retained catheters and continued to peritoneal dialysis, 2 cured. 20 （87%）out of 23 withdrew peritoneal dialysis to hemodialysis. 2 （8. 7% ） died. Conclusion Immediate extubation of PD catheter is advocated in patients with fungal peritonitis. But in special circumstances, it may be appropriate to consider retention catheter in PD patients. However, prospective studies are needed to discuss the details of treatment of PD patients with fun- gal peritonitis.