制霉菌素对腹膜透析霉菌性腹膜炎的预防作用

The Prophylactic Effect of Nystatin in CAPD Fungal Peritonitis

目的:研究持续性非卧床腹膜透析（CAPD）细菌性腹膜炎（BP）在用抗菌素治疗同时应用制霉菌素对霉菌性腹膜炎（FP）发生的预防作用。方法:回顾性研究了1995年6月至2000年11月期间预防组应用制霉菌素（50万单位tid）预防治疗共有细菌性腹膜炎535例次/9970病人月,同期霉菌性腹膜炎37例次,其中原发性霉菌性腹膜炎21例次、继发性霉菌性腹膜炎13例次、复发性霉菌性腹膜炎3例次;未预防组细菌性腹膜炎58例次/969病人月,同期霉菌性腹膜炎7例次,其中原发性1例次、继发性6例次。糖尿病病人16例,4例发生霉菌性腹膜炎;非糖尿病73例,发生3例。结果:未预防组BP的发病率与预防组BP的发病率无明显差别P>0.05。未预防组霉菌性腹膜炎的发病率与预防组霉菌性腹膜炎的发病率无明显差别（P>0.05）。未预防组继发性霉菌性腹膜炎的发病率明显高于预防组P<0.05。未预防组糖尿病与非糖尿病比较糖尿病病人霉菌性腹膜炎发病率高（P<0.05）。结论:细菌性腹膜炎抗菌素的应用是霉菌性腹膜炎发生的危险因素,治疗细菌性腹膜炎的同时应用制霉菌素对霉菌性腹膜炎有预防作用。糖尿病患者较非糖尿病患者易患霉菌性腹膜炎,应积极预防。

OBJECTIVE: study the nystatin prophylactic effect of fungal peritonitis when antibiotic treatment be used during continuous ambulatory peritontal dialysis (CAPD) bacterial peritonitis. METHODS:We studied two groups of CAPD peritonitis patients that nystatin500000u tid was used or prophylaxis was not used during the bacterial peritonitis (BP) from Jun. 1995 to Nov. 2000. There were 535 episodes of BP and 37 episodes of fungal peritonitis (FP) in the corresponding time in nystatin prophylaxis group (source of the patients from Tung Wan hospital). Among 37 episodes of FP 13 episodes were primary, 21 episodes were secondary to BP, 3 episodes were recovery FP. In non-prophylaxis group there was 58 episodes of BP and 7 episodes of FP in the corresponding time (source of the patients from our hospital). Among 7 episodes of FP 1 episodes was primary, 6 episodes were secondary to BP. In non-prophylaxis group there were total 16/89 cases of CAPD patients with DM and there were 4/7 episodes FP patients with DM. RESULTS:Thsre was no difference between the two groups of BP morbidity (P>0.05 )and FP morbidity P>0.05. But morbidity of FP secondary to BP was higher in non-prophylaxis group than prophylaxis group. The morbidity of FP was higher in DM group than in non-DM group. CONCLUSION:Nystatin had a good prophylactic effect on CAPD fungal peritonitis when antibiotic treatment were used during of CAPD bacterial peritonitis. DM was ahazard factor of the incidence of FP, So nystatin should be used especially among them.