腹膜透析相关性腹膜炎的防治

Prevention and treatment of peritoneal dialysis-related peritonitis

腹膜透析(PD)相关性腹膜炎是腹膜透析患者的严重并发症,降低腹膜透析相关感染的风险应该是每个PD中心的重要工作目标。对于出现感染者,应在早期进行经验性治疗,并高质量留取标本,进行有效的微生物学诊断和药敏试验,以保证抗感染治疗的准确性和有效性。腹膜透析中心应积极开展团队质量改进,包括持续进行感染监测、分析感染发生的根本原因。建立全面的腹膜炎风险评估机制,尤其要重点加强主动预防理念,在开始腹膜透析治疗的同时,对高龄、糖尿病患者等高危人群进行重点预防,有意识地加强操作正规培训和再培训、积极防止腹泻和(或)便秘以及加强隧道和出口处护理等主动预防措施,尽可能降低腹膜透析相关性腹膜炎的发生概率。

Peritoneal dialysis-associated peritonitis （PDAP） is a serious complication in peritoneal dialysis patients ; it is an important goal of each PD center to reduce the risk of peritoneal dialysis- associated infection. In case of peritoneal dialysis-associated infection, empirical treatment should be given as early as possible; in the meantime, samples with high quality should be collected for effective microbiologlcal diagnosis and drug sensitivity test so as to ensure the accuracy and effectiveness of anti-infection treatment. Each PD center should actively carry out team continuous quality improvement （CQI） plan, including continuous monitoring of infection, analyzing of the root cause of infection, establishing a mechanism for comprehensive evaluation of the risk of peritonitis, focusing on strengthening active prevention concept, laying emphasis on prevention in high-risk populations such as the olders and diabetes patients from the start of peritoneal dialysis treatment, taking a particular focus on formal training and retrain of operation, actively preventing diarrhea/constipation, and enhancing the nursing care of tunnel and exit-site, in order to reduce the probability of occurrence of PDAP as much as possible.