海南省腹膜透析管路相关并发症及其防治

Catheter Related complication and prevention during P D of tropical zone of Hianan province

目的：分析热带地区海南省近１８年来，持续性不卧床式腹膜透析（ＣＡＰＤ）管子出口处及隧道感染、感染性腹膜炎等管路相关并发症发生率、管子废用率、转归及防治对策。方法：对１９８１年～１９９８年ＣＡ ＰＤ患者１４４例分为三组进行对比分析。Ⅰ组：非“Ｏ”型管道组７４例，Ⅱ组“Ｏ”型管道组（“Ｏ”驼ｔ）７０例，Ⅲ组应用“０”ｓｅｔ行家庭腹膜透析组 ５８例。结果：１４４例中发生管路相关并发症共 １４３例（占 ９９％），其中细菌性感染性腹膜炎 ６９例（占 ４８％）， Ⅰ组５２例（占７０ ％），Ⅱ组６例（占９％）；Ⅲ组１１例（占１９％）。管子出口处感染４７例（占３３％），Ⅰ组３１例（占６６％），Ⅱ组８例（占１１％），Ⅲ组８例（占１４％）。隧道炎２７例（占１８．８％），Ⅰ组１７例（占６３％），Ⅱ组４例（占６％），Ⅲ组６例（占１０％）。１４３例次中，管子出口方向朝向上方占５１％（７４／１４４），出口和隧道感染由金黄色葡萄球菌引起者占６９％（１８／２６）；因管路相关性并发症拔除腹透管７５例，其中因腹膜炎拔管４６例；技管后重新插管能继续腹透１７例，改血液透析２３例，放弃透析３０例。病情缓解停止透析５例。结论：由于新的腹膜透析连接系统的应用，?

Objective:To analysis the prophylactic - thrapeutic Countermeasure and result on exit site and tunnel infection(ESI/TI), infective peritonitis, catheter obsolate rate(Catheter Survival rate) by 144 CAPD patients from 1981 to 1998 years. Methods: 144 CAPDpatients are divide three groups for Comporative analysis. Group I: Non - 'O' set 74 pationts Group Ⅱ: 'O'set 70 patients, Group Ⅲ: 'O' set CAPD at home dialysis 58 patients. Results: Catheter related complication accounted for 99 % (143 cases/144) a total of 144 patients. Among them Infectivie peritonitis 69 cases, make up 48%, the peritonitis occurrence: in group I 52 cases, group Ⅱ 6 cases and group Ⅲ 11 cases. About the peritonitis an average morbidty: group Ⅰ/6 patient month, group Ⅱ1/174 patient month and group Ⅲ were 1/98 patient month(p< 0.01). The ESI average morbidty of Ⅱ、Ⅱ 、Ⅲ group patients were 66. 11 and 14 percent. TI total 27 cases, among them group Ⅰ17 cases, group Ⅱ 4 cases and group Ⅲ were 6 cases. Ramove catheter total 72 patients duto the Catheter related complication make up 50% (72/144), among give up CAPD 30 cases, changes the rapy by Hemodia lysis 23 cases, stoped CAPD for patients condition 5 cases. Conclusion: The peritonitis occur rate pronement lower was due to used the 'O' set of tropical zone of china. But, the ESI/TI occur rate be still high. A downward - directed or placed laterally exit - site was associated with lower peritonitis, in tropical zone, sweating may effect the freguency of early dressing changes, which should be done when the exit - site is wet, when the patients feels itchy under the taped skin, or when the slickiness of the taped is lost, beside, we import one's experience to non - operative treatment aversion of the catheter, used local block therapy TI gain cure 84. 19 percent, it is need plompt to remove crusts, or scabs.