南方高温高湿地区腹膜透析相关性腹膜炎分析

Analysis of Peritoneal Dialysis Associated Peritonitis in High Temperature and Humidity Area in South China

目的分析中国南方高温高湿地区腹膜透析相关性腹膜炎的发生率、常见原因、致病菌菌谱等的特点及季节变化规律,为临床防治提供依据。方法回顾性分析2011年1月～2016年12月在笔者医院234例次腹膜透析(peritoneal dialysis,PD)相关性腹膜炎患者的临床资料;并分析腹膜炎发生率与气温、降水量、季节等气候因素的相关性、致病菌的特点及其转归。结果近6年腹透患者腹膜炎发生率稳定。PD相关性腹膜炎主要原因是操作不规范(29. 49%)和肠源性因素(腹泻、便秘)(29. 91%)。腹膜炎发生率与气温及降水量差异均无统计学意义(P> 0. 05);致病菌分布差异亦无统计学意义(P> 0. 05)。革兰阳性菌是最常见的致病菌,以金黄色葡萄球菌多见;革兰阴性菌多见于大肠杆菌;真菌多见于曲霉菌。结论 PD相关性腹膜炎发生率与湛江地区气温、降水量无关,无季节分布差异。肠源性因素和操作不规范才是PD相关性腹膜炎最常见原因。

Objective To explore the incidence,risk factors,pathogenic bacteria spectrum characteristics and seasonal variation of the peritoneal dialysis related peritonitis in Zhanjiang region,and provide basis for rational selection of regimens.Methods A retrospective analysis of 234 times of peritoneal dialysis(PD)related peritonitis patients were taken from January 2011 and December 2016 in our hospital.The clinical data were collected and we analyzed the correlation between annual incidence rate and climatic factors such as temperature,precipitation and seasonal.Pathogenic characteristics and prognosis were also analyzed.Results The morbidity of peritoneal dialysis associated peritonitis changed smoothly nearly 6 years.The main causes of PD related peritonitis were irregular operation(29.49%)and intestinal factors(diarrhea and constipation)(29.91%).There was no statistical difference between the incidence of peritonitis and temperature and precipitation(P>0.05),also there was no statistical difference in the distribution of pathogenic bacteria(P>0.05).Gram positive bacteria are the most common pathogens,especially staphylococcus aureus.Gram negative bacteria are more common in Escherichia coli.Fungi are common in Aspergillus fumigatus.Conclusion The incidence of PD related peritonitis has nothing to do with temperature and precipitation in Zhanjiang,and there is no seasonal difference.Intestinal origin and nonstandard operation are the most common causes of PD related peritonitis.