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目的探讨腹膜透析(PD)相关性腹膜炎的发生原因及影响因素。方法回顾PD相关性腹膜炎患者51例(75例次)的临床资料,分析腹膜炎的发生原因、危险因素、致病菌及其耐药性。结果引起腹膜炎的主要原因是换液操作不规范和肠道感染。高超敏C反应蛋白及低尿酸是PD相关性腹膜炎发生的独立危险因素(P<0.05)。PD液培养阳性46例次,共分离出病原菌49株,包括革兰阳性菌33株、革兰阴性菌15株、真菌1株。革兰阳性菌对氨苄青霉素、万古霉素、替考拉宁和利奈唑胺耐药率较低;革兰阴性菌对亚胺培南和头孢吡肟耐药率较低。1例患者死亡,9例患者拔管,其余均治愈。结论加强PD换液的无菌操作、及时治疗腹泻和便秘、控制微炎症状态、避免尿酸过度减少、合理选择抗生素是防治PD相关性腹膜炎的有效方法。
Objective To investigate the causes and influencing factors of peritoneal dialysis (PD) -related peritonitis. Methods The clinical data of 51 patients with PD-related peritonitis (75 cases) were retrospectively analyzed. The causes, risk factors, pathogens and drug resistance of peritonitis were analyzed. The main cause of peritonitis caused by fluid handling is not standardized and intestinal infections. High-sensitivity C-reactive protein and low uric acid were independent risk factors for PD-related peritonitis (P <0.05). Forty-six cases were positive for PD liquid culture, and 49 strains of pathogens were isolated, including 33 Gram-positive bacteria, 15 Gram-negative bacteria and 1 fungi. Gram-positive bacteria were less resistant to ampicillin, vancomycin, teicoplanin and linezolid; Gram-negative bacteria were less resistant to imipenem and cefepime. One patient died, nine patients extubated and the rest were cured. Conclusions To enhance the aseptic operation of PD fluid exchange, treat diarrhea and constipation in time, control the state of micro-inflammation and avoid excessive decrease of uric acid, rational selection of antibiotics is an effective way to prevent and treat PD-related peritonitis.