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目的报道腹膜透析相关性丝状真菌腹膜炎1例的诊疗过程及其预后,并结合文献复习以加强对该病诊疗方面的认识。方法回顾性分析解放军第117医院收治的1例腹膜透析相关丝状真菌腹膜炎患者资料,并总结复习相关文献。结果持续性不卧床腹膜透析的女性糖尿病患者,在出现腹膜透析相关性腹膜炎症状后,给予头孢他啶联合头孢唑林抗感染治疗15d,症状无明显改善;随后腹膜透析液培养提示丝状真菌,立即停用抗生素,给予氟康唑抗真菌治疗,并行腹膜透析管拔管术,术中腹膜透析管内奶酪样物质送检培养提示丝状真菌生长。患者拔管后行血液透析治疗,半年后重置腹膜透析管,行腹膜透析治疗,1.5%腹膜透析液4次/日;2周后测尿量650 ml,超滤量-490 ml,残肾尿素清除指数(Kt/V)0.811,腹膜Kt/V 1.832,总Kt/V 2.64/周,残肾内生肌酐清除率(endogenous creatinine clearance rate,Ccr)35.7,腹膜Ccr 38.9,总Ccr 74.6/周,氮表现率蛋白相当量1.12,提示透析充分,营养状况良好,PET试验提示高平均转运型。连续随访3年患者腹膜透析充分,后因无菌操作不规范致反复细菌性腹膜炎,最终诊断为腹膜超滤衰竭,退出腹膜透析,改行血液透析至今。结论目前腹膜透析相关丝状真菌性腹膜炎治疗以拔管后退出腹膜透析为主,而在腹膜炎治愈、一般情况良好的条件下,仍可以考虑腹膜透析管重置。
Objective To report the diagnosis and treatment of peritoneal dialysis associated with filamentous fungal peritonitis and its prognosis, and to review the literature to strengthen the understanding of the diagnosis and treatment of the disease. Methods A retrospective analysis of the 117th Hospital of People’s Liberation Army admitted 1 case of peritoneal dialysis-related filamentous fungal peritonitis patients, and summarize the review of the relevant literature. Results Persistent ambulatory peritoneal dialysis women with diabetes, peritoneal dialysis-related peritonitis symptoms, given ceftazidime combined with cefazolin anti-infective therapy 15d, no significant improvement in symptoms; followed by peritoneal dialysis fluid culture prompt filamentous fungi immediately stop With antibiotics, given fluconazole antifungal therapy, parallel peritoneal dialysis tube extubation, intraoperative peritoneal dialysis tube cheese-like substances submitted to test culture prompted the growth of filamentous fungi. Patients extubation after hemodialysis treatment, reset the peritoneal dialysis catheter after six months, peritoneal dialysis treatment, 1.5% peritoneal dialysis solution 4 times / day; 2 weeks after the test urine output 650 ml, ultrafiltration volume -490 ml, residual kidney Urea clearance index (Kt / V) 0.811, peritoneal Kt / V 1.832, total Kt / V 2.64 / week, endogenous creatinine clearance rate (Ccr) 35.7, peritoneal Ccr 38.9, total Ccr 74.6 / week , Nitrogen equivalent protein equivalent amount of 1.12, suggesting that adequate dialysis, good nutritional status, PET test suggests a high average transfer type. Continuous follow-up of patients with peritoneal dialysis for 3 years, after repeated due to aseptic non-standard bacterial bacterial peritonitis, the final diagnosis of peritoneal ultrafiltration failure, withdrawal from peritoneal dialysis, divert hemodialysis so far. Conclusion Peritoneal dialysis-related filamentous fungal peritonitis is currently the main peritoneal dialysis after extubation, peritoneal dialysis tube replacement can still be considered under the condition of cured peritonitis in general.