尿毒症维持性腹膜透析患者拔管立即重置对临床疗效的影响

Clinical therapeutic effect of catheter removal and immediate replacement of a new one on uremic patients with maintenance peritoneal dialysis

要：目的 探讨尿毒症腹膜透析（PD）拔管重置方法和时机选择对患者临床疗效的影响.方法 回顾性分析2006年6月至2015年6月沈阳市红十字会医院肾内科15例尿毒症PD患者拔管重置的临床资料,分析其拔管重置的原因,观察重新置管后患者预后.结果 15例患者中,2例因大网膜包裹,13例因反复发作性腹膜炎,均采用外科开放式手术拔管后立即于同侧或对侧重新置管,其中同侧置管12例,对侧置管3例.术后患者恢复均良好,未出现腹部切口及隧道的感染.2例大网膜包裹患者行重新置管后几月后再次出现入出液困难,改行血液透析（HD）治疗.1例复发性腹膜炎患者置管2周后因脑出血意外死亡.其中反复发作腹膜炎患者的病情得到有效的控制,阳性体征消失,腹水常规恢复正常,腹水培养阴性,1年内未再出现腹腔感染.结论 本科对尿毒症PD患者采用拔管后立即重新置管的方法,不需要HD过渡,可减轻患者痛苦,避免反复手术,节省了医疗资源,且术后效果肯定,未增加手术切口、隧道及腹腔的感染风险.

Objective To explore the clinical therapeutic effect of catheter exchange method and selection of opportunity on uremic patients with peritoneal dialysis （PD）.Methods The clinical data of 15 uremia patients with PD and catheter exchange admitted to the Department of Nephrology of Shenyang Red Cross Hospital from June 2006 to June 2015 were retrospectively analyzed, their reasons of extubation reset were reviewed and the prognoses of the patients after re-catheterization were observed.Results In 15 cases the patients, there were 2 cases due to omentum wrapping and 13 cases due to recurrent peritonitis, open surgery was applied to remove the catheter and immediately a new one was re-implanted on the same side through the original incision （12 cases） or on the opposite side through a new incision （3 cases）. The surgical results in all the patients were successful without any infection at abdominal incision or tunnel of the tube. After the surgery of catheter exchange for a few months, difficulty in fluid flow through the catheter occurred in 2 patients with omentum wrapping, and they changed to undergo hemodialysis （HD）. One patient with recurrent peritonitis died of cerebrovascular disease accident after catheter implantation for two weeks. The situations of patients with multiple episodes of peritonitis were effectively controlled, the positive signs disappeared, the routine laboratory examination of abdominal fluid returned to normal, the fluid bacterial culture negative, and these cases had no relapsing peritonitis any more within 1 year after catheter exchange.Conclusions The method of extubation and immediate re-implantation with a new catheter is applied in uremic PD patients. It is not necessary to use excessive HD to relieve the patients＇ suffering, thus the patient can avoid reoperation and pay more medical expense. Moreover, the postoperative effect of this catheter exchange is confirmed, and no risk of increasing infection at the surgical incision, tunnel and abdominal cavity is seen.