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祝国宁,朱亚瑾,包胜梅,李群,曹吴冰.基层腹透中心50例透析相关性腹膜炎诊治分析[J].浙江中西医结合杂志,2018,28(9):
基层腹透中心50例透析相关性腹膜炎诊治分析
Analysis of diagnosis and treatment of 50 cases of dialysis related peritonitis in basic-level peritoneal dialysis center ZHU Guoning, ZHU Yajing, BAO Shengmei, LI Qun, CAO Wubing (Department of Chinese and western medicine combined with nephrology, Longyou County People"s Hospital, Zhejiang 324400, China)
投稿时间:2018-03-22  修订日期:2018-07-24
DOI:
中文关键词:  腹膜透析  腹膜透析相关性腹膜炎  致病菌
英文关键词:Peritoneal dialysis  Peritoneal dialysis associated peritonitis  Pathogenic bacteria
基金项目:
作者单位E-mail
祝国宁 龙游县人民医院 xk.bangbang@163.com 
朱亚瑾 龙游县人民医院  
包胜梅 龙游县人民医院  
李群 龙游县人民医院  
曹吴冰 龙游县人民医院  
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中文摘要:
      【】目的:探讨基层腹透中心透析相关性腹膜炎(简称腹膜炎)患者的致病菌分布、初始治疗药物选择,病情的转归及预后,从而为基层腹膜炎临床诊治提供依据。方法:回顾分析2015年2月~2017年8月期间于我院腹膜透析中心住院的50例腹膜炎患者的病例资料,分析腹膜炎致病菌分布、诊治及预后。结果:50例CAPD腹膜炎患者中,病原菌培养阳性共有34例,阳性率为68%。其中革兰氏阳性菌20例(40%)革兰氏阴性菌12例(24%),真菌2例(4%)。致病菌以链球菌、葡萄球菌、肺炎克雷伯菌、大肠埃希菌多见,革兰氏阳性菌对青霉素、头孢类抗生素耐药率高,对万古霉素、利福平敏感;革兰氏阴性菌对亚胺培南、哌拉西林/他唑巴坦、阿米卡星耐药率低。50例初始药物选用第1代头孢+氨基糖甙类治愈29例次(58%),革兰氏阳性20例,初始药物治愈率7%;革兰氏阴性12例,初始药物治疗率75%;培养阴性 16 例,初始治愈率75%。结论:本中心腹膜透析患者发生腹膜透析相关性腹膜炎的主要原因为换液操作不规范和肠道感染,致病菌主要为革兰阳性球菌。结合细菌培养和药敏试验结果,既往头孢唑林/阿米卡星联合治疗作为腹膜炎初始治疗方案的选择,存在治疗效果欠佳,建议初始治疗方案选择更适合的万古霉素/阿米卡星联合治疗方案,提高基层腹膜透析相关腹膜炎初始治疗的成功率。
英文摘要:
      Objective To study the distribution of pathogenic bacteria, the initial drug treatment and the prognosis of the dialysis related peritonitis in basic-level peritoneal dialysis center so as to provide basis for the clinical treatment of peritonitis. Methods Peritoneal dialysis fluid drainage of 50 cases of patients with peritonitis in our hospital during the period from February 2015 to August 2017 in were collected, and the distribution of peritonitis pathogenic bacteria, the initial treatment and prognosis were analyzed. Results There were 34 cases of pathogenic bacteria culture-positive (68%), 20 cases of gram-positive bacteria (40%), 12 cases of gram-negative bacteria (24%), 2 cases of fungus (4%). Most of the pathogenic bacteria were streptococcus, staphylococcus, klebsiella pneumoniae and escherichia coli. The gram-positive bacteria were high in antibiotic resistance of penicillin and cephalosporin, and were sensitive to vancomycin and rifampicin, and the gram-negative bacteria were low in the drug resistance rate of amines, piperacillin/tazobaltan and amikacin. Among the 50 cases treated with first generation cephalosporin and aminophenoside, 29 cases were cured (58%), the initial cure rate of 20 cases of gram-positive bacteria was 7%, the initial cure rate of 12 cases of gram-negative bacteria was 75%, the initial cure rate of 16 negative cases was 75%. It is suggested that it has the advantages of high efficiency, high cure rate and good long-term prognosis and is suitable for the initial treatment of peritonitis. Conclusion The main causes for peritoneal dialysis in patients with peritoneal dialysis were the irregular operation and intestinal infection. The pathogenic bacteria were mainly gram-positive bacteria. Considering with bacterial culture and drug susceptibility test results, the combined treatment of cefazolin and amikacin was a poor effective treatment for initial treatment of peritonitis. It is suggested that the combined treatment of vancomycin and amikacin maybe a more suitable choice for the initial treatment plan, thus improving the success rate of initial treatment of the dialysis related peritonitis.
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