口服氟康唑对细菌性腹膜炎腹膜透析患者继发真菌性腹膜炎的影响

Effect of oral administration of fluconazole on secondary fungal peritonitis in bacterial peritonitis patients undergoing peritoneal dialysis

目的探讨持续非卧床腹膜透析患者细菌性腹膜炎治疗同时，予口服氟康唑对继发真菌性腹膜炎发生的影响。方法选取医院2008年1月-2012年12月160例细菌性腹膜炎患者进行前瞻性队列研究，随机分为干预组和对照组，每组各80例；干预组在腹腔给药抗感染期间同时予氟康唑100mg，每天1次口服，对照组仅单纯给予腹腔给药抗感染治疗，抗感染治疗疗程结束后1～5个月观察真菌性腹膜炎发生率，以评估预防性治疗的有效性；采用SPSS软件进行统计分析，两样本发病率的比较采用x^2检验。结果干预组仅2例出现继发性真菌性腹膜炎，发生率为2．5％，对照组发生9例继发性真菌性腹膜炎，发生率为11．3％，两组比较差异有统计学意义（P＜0．05），同时期发现2例原发性真菌性腹膜炎，所有真菌性腹膜炎均予氟康唑静脉注射抗真菌治疗。结论腹膜透析患者患细菌性腹膜炎时使用抗菌药物易导致继发性真菌性腹膜炎发生；在治疗细菌性腹膜炎疗程中，同时使用氟康唑可显著地减少继发性真菌性腹膜炎的发生。

OBJECTIVE To observe the effect of oral administration of fluconazole on secondary fungal peritonitis in the patients with bacterial peritonitis who underwent the continuous non-bedridden peritoneal dialysis. METHODS A prospective cohort study was conducted for 160 patients with bacterial peritonitis who were treated in the hospital from Jan 2008 to Dec 2012; the subjects were randomly divided into the intervention group and the control group, with 80 cases in each. The intervention group was treated with intraperitoneal drug administration combined with flueonazole, oral administration once for each day; the control group was only given the intraperitoneal drug administration. After the treatment course for 1 to 5 months, the incidence of fungal peritonitis was observed to evaluate the effectiveness of the preventive treatment; the statistical analysis was performed with the use of SPSS software, and the morbidity rate was compared between the two groups by means of the chi-square test. RESULTS The secondary fungal peritonitis occurred in 2 cases in the intervention group with the incidence of 2.5%and in 9 cases in the control group with the incidence of 11.3%, and there was significant difference （P〈0.05）, meanwhile, the primary fungal peritonitis occurred in 2 cases, and all the patients with fungal peritonitis received the intravenous administration of flueonazole for anti-fungal treatment. CONCLUSION The use of antibiotics tends to result in the secondary fungal peritonitis in the bacterial peritonitis patients undergoing the peritoneal dialysis. During the treatment of bacterial peritonitis, the combination use of flueonazole can effectively reduce the incidence of the secondary fungal peritonitis.