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腹膜透析是终末期肾脏病患者有效的肾脏替代治疗方式之一,其优点为操作简便,可居家进行腹膜透析治疗,节省医疗资源。随着腹膜透析技术的不断改进,接受腹膜透析治疗的患者逐年增加。腹膜透析也有并发症,胸腹瘘是腹膜透析少见却严重的并发症,严重影响腹膜透析患者的透析质量。本文分析总结了2014年1月-2016年10月某院肾病中心5例腹膜透析并发胸腹瘘患者的临床资料。5例患者均出现胸闷,超滤量减少,胸片提示右侧大量胸腔积液。胸水为漏出液,胸水蛋白低,胸水葡萄糖高于同期血糖。3例患者美蓝试验阳性,5例患者DPTA试验均为阳性。经抽取胸水、暂停持续不卧床腹膜透析、改行间隙性小剂量腹膜透析等治疗效果欠佳。5例患者均拒绝尝试胸腔化学粘连法、瘘修补术,最终都转为血液透析治疗。
Peritoneal dialysis is one of the effective renal replacement therapy for patients with end-stage renal disease, which has the advantages of simple operation, peritoneal dialysis treatment at home and saving of medical resources. With the continuous improvement of peritoneal dialysis technology, peritoneal dialysis patients receiving increased year by year. Peritoneal dialysis also has complications, peritoneal fistula is a rare but serious complications of peritoneal dialysis, seriously affecting the quality of dialysis patients with dialysis. This article analyzes and summarizes the clinical data of 5 cases of peritoneal dialysis complicated with thoracoabdominal fistula from January 2014 to October 2016 in a hospital nephropathy center. All 5 patients had chest tightness and decreased ultrafiltration volume. A large amount of pleural effusion was indicated on the right side of the chest radiograph. Pleural effusion, pleural effusion protein low, pleural effusion glucose higher than the same period. 3 patients with methylene blue test was positive, 5 patients were positive for DPTA test. The extraction of pleural effusion, continuous ambulatory peritoneal dialysis suspended, diverting intermittent low-dose peritoneal dialysis treatment ineffective. All 5 patients refused to try thoracic chemoembolization, fistula repair, and eventually turned to hemodialysis.