腹膜透析患者并发胸腹瘘5例分析

Clinical survey on 5 peritoneal dialysis cases complicated with chest abdominal fistula

目的探讨腹膜透析患者并发胸腹瘘的临床表现、诊断方法及治疗与转归。方法对2011年1月—2014年12月收治的腹膜透析并发胸腹瘘患者5例的临床表现、诊断方法及治疗与转归进行分析。结果 5例患者均出现胸闷、气促;影像学检查提示中～大量右侧胸腔积液;胸水透明清亮,蛋白定性试验阴性,胸水蛋白定量〈25g/L,葡萄糖〉40 mmol/L,美蓝试验阳性,DPTA试验阳性。确诊后经抽取胸水、暂停持续非卧床腹膜透析,其中4例患者最终转为血液透析治疗,1例改为间歇性腹膜透析,瘘口愈合后再行维持性腹膜透析。结论胸腹瘘有胸腔负压消失的临床特点,用美蓝试验及核素扫描结合胸水生化成分分析诊断胸腹瘘敏感性高,不良反应少。出现胸腹瘘后患者大多转为维持性血液透析,较难再维持腹膜透析治疗。

Objective To investigate the clinical manifestations,diagnostic methods and treatment of peritoneal dialysis patients with thoracoabdominal fistula.Methods From 2011 January to 2014 December,5 patients with peritoneal dialysis complicated with thoracic abdominal fistula were enrolled,the clinical manifestations,diagnostic methods and treatment and prognosis of them was analyzed.Results These 5 patients had chest tightness,shortness of breath;imaging revealed a medium to large amount of right pleural effusion;pleural effusion is transparent and clear,protein qualitative test was negative,pleural effusion protein quantitative 〈25 g/L,glucose〉 40 mmol/L,methylene hlue test is positive,DPTA test revealed positive result.After the diagnosis,by pleural effusion drainage,suspended extraction of continuous ambulatory peritoneal dialysis.4 cases of patients eventually changed to hemodialysis therapy,I cases changed to intermittent peritoneal dialysis,after fistula healing,peritoneal dialysis were conti-nued.Conclusion Thoraco-abdominal fistula has the clinical features of intrathoracic negative pressure disappeared,with methylene blue test and radionuclide scan combined with pleural effusion＇s biochemical component analysis,the diagnosis of thoracic and abdominal fistula revealed high sensitivity,less adverse reaction.After occurred with thoraco-abdominal fistula,most patients changed to maintenance hemodialysis,peritoneal dialysis treatment is difficult to maintain.