腹腔预防性应用抗生素对腹膜透析置管术后发生腹膜炎的临床探讨

The effect of prophylactic use of antibiotics in peritoneal cavity after catheter insertion on the incidence of peritonitis

目的观察腹膜透析置管术后预防性应用抗生素是否影响休整期腹膜炎的发生。方法回顾性分析我院2011年1月至2012年12月接受腹膜透析患者53例,其中男性29例,女性24例,年龄26～83岁,平均年龄(63.9±12.83)岁。根据腹透置管术后的封管方式分为两组,A组33例,术后给予腹透液500ml冲洗腹腔,并应用20mg肝素加200ml腹透液中灌注腹腔封管。B组20例,术后以相同的方法冲洗腹腔后,应用20mg肝素加头孢唑啉1.0g加200ml腹透液中灌注腹腔,如头孢唑啉过敏者应用庆大霉素4万U。腹膜透析时观察腹膜透出液的性质、透明度等,对可疑患者立即留取存腹4h腹膜透出液标本进行常规检查,并同时留取标本进行细菌学培养。结果 A组33例中发生腹膜炎6例,占18%,B组20例中发生腹膜炎1例,占5%,两组间比较差异无统计学意义(P>0.05)。结论术后腹腔应用抗生素对于预防休整期腹膜炎是否有意义,有待进一步探讨。

Objective To observe whether prophylactic antibiotics has influence on the incidence of peritonitis during break-in period.Methods We retrospectively summarized 53 patients who were treated with peritoneal dialysis during a period of two years in our hospital,24 females and 29 males,mean age（63.9 ±12. 83）years.These patients were divided into two groups according to the methods of tube sealing after PD catheter insertions.Group A：used 500ml dialysis solution（13ianeal）to wash abdominal cavity after surgery and perfuse abdominal cavity with 20 mg heparin ＋200 ml Dianeal.Group B： used the same method in group one to wash abdominal cavity after surgery and perfuse abdominal cavity with 20 mg heparin＋1.0 g cefazolin＋200 ml Dianeal（ if the patients were allergic to cefazolin, 40000 U gentamicin could be used instead）. The quality, the transparency and some other aspects of the effluents should be observed after each drainage. If there was any suspicious case for peritonitis, an immediate test for the effluent of 4 hours dwell would be performed. At the same time,a bacteria culture should also be done. Results Six of 33 patients（ 18 % ）in the Group A and one of 20 patients（5 % ）in the Group B had experienced peritonitis episodes.There was no significant difference between the two groups.Conclusion There was no significant effect of using antibiotics in peritoneal cavity to prevent peritonitis during break in period peritonitis after catheter insertion.