频发性腹膜透析相关性腹膜炎的临床特点及危险因素的探究

发布时间：2018-04-15 13:48

  本文选题：腹膜透析 + 频发性腹膜炎　； 参考：《安徽医科大学》2017年硕士论文

【摘要】：背景目前,腹膜透析(peritoneal dialysis,PD)技术已广泛应用于终末期肾脏病(end-stage renal disease,ESRD)的治疗,成为终末期肾脏病的主要肾脏替代治疗方法之一。腹膜炎一直被视为腹膜透析首要的且最为严重的并发症。在20世纪80年代初,PD相关性腹膜炎发生率高达6.3次/病人年[1],1986年,国家卫生研究院关于持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)的登记报告显示,该比率降至1.07-1.47次/患者年,2004年降至0.4次/患者年[2,3]。随着科学技术进步,虽然PD相关性腹膜炎的发生率在过去十年里有所降低,但仍然占所有技术失败的1/3[4],依然是导致患者住院率增加、退出腹膜透析、腹膜功能衰竭及死亡的主要原因。腹膜透析相关性腹膜炎的发病率和风险因素在不同国家之间,甚至在同一国家不同透析中心之间也有所不同。本文进行单中心回顾性研究,分析腹膜炎多次发生的相关危险因素,为预防和治疗腹膜炎提供有效理论依据,从而降低PD相关性腹膜炎的发病率,提高患者的生存质量和生存率。目的分析频发性腹膜透析相关性腹膜炎的临床特点,并探究其危险因素。方法回顾性研究2007年1月至2014年12月,在安徽省立医院行腹膜透析置管术后予以CAPD治疗的70例ESRD患者,选择1年内发生腹膜炎≥2次者定义为频发组,1年内仅发生1次腹膜炎者定义为单发组,比较两组间人口学特征、临床资料及实验数据的差异,并分析本中心腹膜炎反复发生的危险因素。结果共70例患者发生感染性腹膜炎,其中,频发组13例,发生腹膜炎30例次,单发组57例,发生腹膜炎57例次。频发组与单发组相比,患者血压和体质量指数(body mass index,BMI)明显升高(P0.05),未及时治疗者[7例(53.85%)比13例(22.81%)]及抗感染疗程不足者[5例(38.46%)比8例(14.04%)]增多(P0.05),无效拔管率[5例(38.46%)比7例(12.28%)]增加(P0.05),血红蛋白、血白蛋白显著降低(P0.05),全段甲状旁腺素(intact parathyroid hormone,i PTH)水平升高(P0.05)。病原学检查分析频发组革兰阴性菌和真菌所占比例之和增加(P0.05),但以革兰阴性菌增加的趋势最明显(P0.05)。2组间置管时年龄、性别、透析时间、原发病、文化程度、腹膜炎诱因、病死率、残余肾功能、血白细胞、血钙、血磷、C反应蛋白、总胆固醇、三酰甘油、首次腹透液白细胞数比较差异均无统计学意义。Logistic回归分析显示高体质量指数、严重高血压、低血红蛋白、低血白蛋白为频发性腹膜透析相关性腹膜炎的危险因素。结论在频发性PD相关性腹膜炎中,革兰阴性菌和真菌所占总比例增加;营养不良、体质量指数过高、严重高血压为频发性PD相关性腹膜炎的危险因素;继发性甲状旁腺功能亢进、首次腹膜炎发生时未及时治疗和疗程不足也可能导致腹膜炎反复发生。积极纠正低蛋白血症、控制血压和i PTH水平、保持标准体质量指数,及时规范治疗感染性腹膜炎有助于该病的防控和改善预后。
[Abstract]:Background at present, peritoneal dialysis (PD) has been widely used in the treatment of end-stage renal disease (ESRD), and has become one of the main renal replacement therapy for end-stage renal disease.Peritonitis has been regarded as the primary and most serious complication of peritoneal dialysis.In the early 1980s, the incidence of PD-related peritonitis was as high as 6.3 times per patient year [1]. In 1986, the National Institutes of Health (NIH) registered continuous ambulatory peritoneal dialysism (CAPDD).The ratio decreased to 1.07-1.47 / patient year and 0.4 / patient year in 2004.With advances in science and technology, although the incidence of PD-related peritonitis has decreased over the past decade, it still accounts for a third of all technical failures, which still contribute to an increase in patient hospitalizations and withdrawal from peritoneal dialysis.The main causes of peritoneal failure and death.The incidence and risk factors of peritoneal dialysis-associated peritonitis vary from country to country or even from dialysis center to country.A single center retrospective study was conducted to analyze the risk factors associated with multiple peritonitis in order to provide an effective theoretical basis for the prevention and treatment of peritonitis and to reduce the incidence of PD-related peritonitis.Improve the quality of life and survival rate of patients.Objective to analyze the clinical features and risk factors of frequent peritoneal dialysis associated peritonitis.Methods from January 2007 to December 2014, 70 patients with CAPD were treated with CAPD in Anhui Provincial Hospital.The patients with peritonitis 鈮，

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