持续性非卧床腹膜透析患者腹膜炎病因和危险因素分析及护理对策

Etiology and risk factors analysis of peritonitis in continuous ambulatory peritoneal dialysis patients and nursing countermeasure

目的分析连续性非卧床腹膜透析(CAPD)患者腹膜炎病因及其相关危险因素并探讨护理策略。方法回顾性分析142例CAPD患者的临床资料,总结腹膜炎患者的病因、治疗、转归及其危险因素等。结果病因与危险因素:21例腹膜炎患者,总感染率为14.7%,累积发生感染26例次。3人出现2次及以上感染。常见危险因素依次为耗材重复利用、手消毒不严格、腹泻便秘、营养不良、透析时间(>5年)。依据危险因素和21例患者各自感染原因可简单分为接触感染(14例)、肠道感染(5例)及低免疫力(2例)。临床表现与治疗、转归:腹膜炎常见临床表现依发生频率依次为,腹痛21例,发热17例,引流不畅16例,呕吐腹泻8例、浮肿5例。经禁食、胃肠减压、补液、抗感染等综合处理后,17例治愈继续行腹膜透析治疗,4例治疗无效,拔管后改血液透析治疗。结论依据引起CAPD患者腹膜炎常见病因的各危险因素,护理人员从无菌观念、培训指导、随访家访、膳食指导以及心理疏导方面加强对应工作,可有效降低腹膜炎的发生率。

Objective To analyze the etiology and related risk factors of peritonitis in continuous ambulatory peritoneal dialysis（CAPD） patients and to explore the corresponding nursing countermeasure. Methods The clinical data of 142 patients with CAPD were retrospectively analyzed, the etiology, treatment, outcome and risk factors of peritonitis were summarized. Results Etiology and risk factors： 21 cases of peritonitis, the total infection rate was 14.7%, cumulative infection occurred in 26 cases. 3 people had 2 and more infections. Common risk factors were repeated consumption of materials, unstrict hand disinfection, diarrhea constipation, malnutrition and dialysis time（5 years）. According to the risk factors and the reasons of 21 patients＇ infection, they could be classified into contact infection（14 cases）, intestinal infection（5 cases） and low immunity（2 cases）. Clinical manifestations, treatment and outcomes： the frequent clinical manifestations of peritonitis were in turn, 21 cases of abdominal pain, 17 cases of fever, 16 cases of drainage unobstructed, 8 cases of vomiting and diarrhea and 5 cases of edema. After the comprehensive treatment of fasting, gastrointestinal decompression, fluid infusion and anti infection, 17 cases continued to be treated with peritoneal dialysis after the cure and4 cases were not effective. After extubation, the treatment was changed to hemodialysis. Conclusion According to the risk factors causing the common etiology of peritonitis in CAPD patients, the nursing personnel strengthen their corresponding work from the aseptic concept, training guidance, follow-up home visits, dietary guidance and psychological counseling aspects, which can effectively reduce the incidence of peritonitis.