腹膜透析相关性腹膜炎危险因素

Risk factors for peritonitis caused by peritoneal dialysis and its prognosis

目的研究腹膜透析相关性腹膜炎致病菌、危险因素以及预后。方法选取2014年1月至2017年3月于本院进行腹膜透析的188例患者为研究对象,根据是否发生腹膜透析相关性腹膜炎分为未发生组(104例)和发生组(84例),确诊后24 h内,无菌留取透析液进行致病菌分析。采用单因素及Logistic回归多因素分析导致腹膜透析相关性腹膜炎发生的危险因素,并统计患者转归情况。结果 84例腹膜透析相关性腹膜炎患者共检出病原菌122株,其中革兰阳性菌75株(61.48%),以表皮葡萄球菌为主,革兰阴性菌44株(36.06%),真菌3株(2.46%)。单因素及Logistic多因素分析结果显示,年龄≥55岁、合并糖尿病及胃肠道紊乱、白蛋白<30 g/L、血红蛋白<90 g/L是腹膜透析相关性腹膜炎发生的危险因素(P<0.05)。84例发生组中治愈78例,治愈率为92.86%(78/84),退出腹膜透析治疗6例,发生率为7.14%(6/84),均为革兰阴性菌感染,且3例合并真菌感染。结论年龄大、合并糖尿病及胃肠道紊乱、白蛋白低、贫血是腹膜透析相关性腹膜炎发生的危险因素。对于革兰阴性菌或者真菌感染的患者治疗效果较差,临床应根据患者致病菌检查结果选择治疗方案。

Objective To study the risk factors and prognosis of peritoneal dialysis related peritonitis. Methods 188 patients with peritoneal dialysis in our hospital from January 2014 to March 2017 were selected as the research subjects anddivided into the no occurrence group（n=104 cases）and the occurrence group（n=84 cases）according to occurance ofperitoneal dialysis related peritonitis,and within 24 hours after diagnosis,pathogenic bacteria were analyzed by asepticretention dialysis solution. Single factor and logistic regression were used to analyze the risk factors for peritonitis associatedwith peritoneal dialysis and the patients＇ outcome was statistically assessed. Results 122 strains of pathogenic bacteriawere found in 84 peritoneal dialysis related peritonitis patients,and among them,there were 75 strains of gram positivebacteria（61.48%）,which were mainly Staphylococcus epidermidis,and 44 strains of gram negative bacteria（36.06%）and 3 strains of fungi（2.46%）. Single factor and logistic multivariate analysis showed diabetic complication,gastrointestinaldisturbance in patients more than and equal 50 years old,albumin 30 g/L and hemoglobin 90 g/L were risk factors ofperitoneal dialysis related peritonitis（P〈0.05）. 78 cases of the 84 patients were cured and the cure rate was 92.86%. 6 cases were discharged from peritoneal dialysis and the incidence rate was 7.14%;all of which were gram-negative bacteriainfection,and 3 cases were complicated with fungal infection. Conclusion For patients with peritoneal dialysis associatedperitonitis,the analysis of pathogenic types and risk factors has laid the foundation for rational selection of drugs.