273例次腹膜透析相关性腹膜炎临床特征分析

Clinical Characters of 273 Times of Peritoneal Dialysis-related Peritonitis

目的分析腹膜透析相关性腹膜炎发生的临床特征,探讨防治对策。方法分析本院腹膜透析中心2007年1月—2014年5月诊治的273例次腹膜透析相关性腹膜炎患者发病年龄、性别、透析时间、发病季节、血红蛋白、血清白蛋白、细菌种类及预后情况等。结果 273例次腹膜透析相关性腹膜炎60岁以上者占52.7%;透析由患者本人操作者占47.6%;透析2年内者占59.0%;共有203例次细菌培养阳性,阳性率为74.3%,G^+菌占60.1%,G^-菌占34.5%,真菌占2.9%,结核菌占1.0%,混合感染占1.5%;发生感染时处于贫血状态者占82.8%,血清白蛋白在35 g/L以下者占92.7%;G^+组与培养阴性组的各项预后指标差异无统计学意义(P>0.05),而G^-组与培养阴性组的治愈率和退出率差异有统计学意义(P<0.05)。结论 G^-组的治愈率比培养阴性组低,退出率比培养阴性组高。老年人、透析2年内及低白蛋白血症、贫血、本人操作腹膜透析者是本中心腹膜炎发生率较高的影响因素,因此,要重视G^-菌腹膜炎的防治,加强对腹膜透析患者初始腹膜透析操作的培训和定期再评估、培训以预防其发生。

Objective To analyze the clinical characteristics of peritoneal dialysis-related peritonitis and explore its countermeasures. Methods We retrospectively analyzed 273 cases of peritoneal dialysis-related peritonitis with onset age, gender,duration of dialysis, onset season, hemoglobin, serum albumin, bacterial species and prognosis in our dialysis center from January2007 to May 2014. Results There were no significant differences of 273 patients with peritoneal dialysis-related peritonitis in terms of onset season and gender. Patients aged over 60 accounted for 52.7 % and patients themselves serving as operators of PD 47.6% and those with two years of dialysis 59.0%. Distributions of G~＋ bacteria, G^- bacteria, fungi, tuberculosis and poly infection were 60.1%, 34.5%, 2.9%, 1.0%,1.5% respectively; anemia status in the event of infection accounted for 82.8% and serum albumin below 35 g/L for 92.7%. Prognostic indicators between G~＋ and culture negative group were statistically insignificant while recovery and dropout rates in G^-and culture negative group were statistically significant（P〈0.05）. Conclusion Recovery rate of G^-group was lower than that of culture-negative group but dropout rate of G^-group was higher than that of culture-negative group. Aged patients,patients with 2-year of dialysis and hypoalbuminemia, anemia, patients themselves serving as PD operators are risk factors of incidence. Therefore, we should pay more attention to the prevention and treatment of G^-bacteria peritonitis, strengthen the initial training and regular operation re-evaluation in peritoneal dialysis for the occurrence of peritonitis.