本文選題：腹膜透析 + 頻發(fā)性腹膜炎��； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景目前,腹膜透析(peritoneal dialysis,PD)技術(shù)已廣泛應(yīng)用于終末期腎臟病(end-stage renal disease,ESRD)的治療,成為終末期腎臟病的主要腎臟替代治療方法之一。腹膜炎一直被視為腹膜透析首要的且最為嚴(yán)重的并發(fā)癥。在20世紀(jì)80年代初,PD相關(guān)性腹膜炎發(fā)生率高達6.3次/病人年[1],1986年,國家衛(wèi)生研究院關(guān)于持續(xù)性非臥床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)的登記報告顯示,該比率降至1.07-1.47次/患者年,2004年降至0.4次/患者年[2,3]。隨著科學(xué)技術(shù)進步,雖然PD相關(guān)性腹膜炎的發(fā)生率在過去十年里有所降低,但仍然占所有技術(shù)失敗的1/3[4],依然是導(dǎo)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。腹膜透析相關(guān)性腹膜炎的發(fā)病率和風(fēng)險因素在不同國家之間,甚至在同一國家不同透析中心之間也有所不同。本文進行單中心回顧性研究,分析腹膜炎多次發(fā)生的相關(guān)危險因素,為預(yù)防和治療腹膜炎提供有效理論依據(jù),從而降低PD相關(guān)性腹膜炎的發(fā)病率,提高患者的生存質(zhì)量和生存率。目的分析頻發(fā)性腹膜透析相關(guān)性腹膜炎的臨床特點,并探究其危險因素。方法回顧性研究2007年1月至2014年12月,在安徽省立醫(yī)院行腹膜透析置管術(shù)后予以CAPD治療的70例ESRD患者,選擇1年內(nèi)發(fā)生腹膜炎≥2次者定義為頻發(fā)組,1年內(nèi)僅發(fā)生1次腹膜炎者定義為單發(fā)組,比較兩組間人口學(xué)特征、臨床資料及實驗數(shù)據(jù)的差異,并分析本中心腹膜炎反復(fù)發(fā)生的危險因素。結(jié)果共70例患者發(fā)生感染性腹膜炎,其中,頻發(fā)組13例,發(fā)生腹膜炎30例次,單發(fā)組57例,發(fā)生腹膜炎57例次。頻發(fā)組與單發(fā)組相比,患者血壓和體質(zhì)量指數(shù)(body mass index,BMI)明顯升高(P0.05),未及時治療者[7例(53.85%)比13例(22.81%)]及抗感染療程不足者[5例(38.46%)比8例(14.04%)]增多(P0.05),無效拔管率[5例(38.46%)比7例(12.28%)]增加(P0.05),血紅蛋白、血白蛋白顯著降低(P0.05),全段甲狀旁腺素(intact parathyroid hormone,i PTH)水平升高(P0.05)。病原學(xué)檢查分析頻發(fā)組革蘭陰性菌和真菌所占比例之和增加(P0.05),但以革蘭陰性菌增加的趨勢最明顯(P0.05)。2組間置管時年齡、性別、透析時間、原發(fā)病、文化程度、腹膜炎誘因、病死率、殘余腎功能、血白細胞、血鈣、血磷、C反應(yīng)蛋白、總膽固醇、三酰甘油、首次腹透液白細胞數(shù)比較差異均無統(tǒng)計學(xué)意義。Logistic回歸分析顯示高體質(zhì)量指數(shù)、嚴(yán)重高血壓、低血紅蛋白、低血白蛋白為頻發(fā)性腹膜透析相關(guān)性腹膜炎的危險因素。結(jié)論在頻發(fā)性PD相關(guān)性腹膜炎中,革蘭陰性菌和真菌所占總比例增加;營養(yǎng)不良、體質(zhì)量指數(shù)過高、嚴(yán)重高血壓為頻發(fā)性PD相關(guān)性腹膜炎的危險因素;繼發(fā)性甲狀旁腺功能亢進、首次腹膜炎發(fā)生時未及時治療和療程不足也可能導(dǎo)致腹膜炎反復(fù)發(fā)生。積極糾正低蛋白血癥、控制血壓和i PTH水平、保持標(biāo)準(zhǔn)體質(zhì)量指數(shù),及時規(guī)范治療感染性腹膜炎有助于該病的防控和改善預(yù)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，

本文編號：1754382