本文選題：腹膜透析 + 腹膜炎�。� 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：PD因其自身的一些特點(diǎn)和優(yōu)越性，被越來越多的人們所接受。隨著治療的不斷規(guī)范化，，腹膜炎的發(fā)生率顯著下降，但它仍是腹膜透析最常見的并發(fā)癥，也是導(dǎo)致患者住院率、死亡率及不能堅(jiān)持腹膜透析的主要原因。長期大量使用抗菌藥物，微生物構(gòu)成譜不斷發(fā)生變化，耐藥菌株也逐漸增加。所以了解PD相關(guān)性腹膜炎的臨床特征、致病菌及耐藥率變化是臨床面臨的現(xiàn)實(shí)問題。本文對相關(guān)因素進(jìn)行分析，從而指導(dǎo)臨床實(shí)踐針對相應(yīng)因素采取有效措施，提高醫(yī)院的感染治愈率，改善患者的生活質(zhì)量。 目的 回顧性分析吉林大學(xué)第一醫(yī)院二部近2年持續(xù)性不臥床腹膜透析(continuous ambulatory peritoneal dialysis，CAPD)相關(guān)性腹膜炎患者的臨床資料，總結(jié)腹膜炎的一般臨床特征、致病菌譜及耐藥率變化，為治療腹膜炎提供臨床依據(jù)。 資料與方法 選取2011年6月-2013年6月吉林大學(xué)第一醫(yī)院二部收治的腹膜透析相關(guān)性腹膜炎患者，作為研究對象，歸為腹膜炎組；同時(shí)，選取同期相應(yīng)的未發(fā)生腹膜炎的CAPD患者，歸為對照組，分析兩組的臨床資料，探討腹膜炎的臨床特征、菌群分布及耐藥率變化等。 結(jié)果 （1）兩組患者的年齡、性別、婚姻、支付方式、透析月、原發(fā)疾病構(gòu)成等基線資料無明顯差異。 （2）腹膜炎組患者外周血白細(xì)胞數(shù)高于對照組（P0.01），腹膜炎組中性粒細(xì)胞比例亦高于對照組(P0.01)，腹膜炎組血紅細(xì)胞、紅細(xì)胞比容、血紅蛋白低于對照組(P0.05)。 （3）腹膜炎組血清鉀、鈉、氯、鈣水平低于對照組(P0.05)；腹膜炎組磷也低于對照組，但兩組間比較無統(tǒng)計(jì)學(xué)意義（P＞0.05）。 （4）腹膜炎組患者血清白蛋白水平明顯低于對照組(P0.05)。腹膜炎組前白蛋白也低于對照組，但差異無統(tǒng)計(jì)學(xué)意義（P0.05）。腹膜炎組鐵蛋白水平均明顯高于對照組(P0.01)。 （5）腹膜炎組與對照組在腹透管出口位置（右/左）方面差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）；兩組在置管醫(yī)院（我院/外院）方面亦無統(tǒng)計(jì)學(xué)差異（P＞0.05）；腹膜炎組腹瀉/便秘情況高于對照組，兩組間比較有統(tǒng)計(jì)學(xué)意義(P0.01)；腹膜炎組血肌酐低于對照組，兩組間比較無統(tǒng)計(jì)學(xué)意義（P0.05），腹膜炎組尿素氮也低于對照組，但兩組間比較有統(tǒng)計(jì)學(xué)意義(P0.01)。 （6）在57例次CAPD腹膜炎患者中，共有42例次培養(yǎng)陽性，陽性率為73.68%，共培養(yǎng)病原菌46株，其中革蘭陽性菌19株，構(gòu)成比為41.30%，革蘭陰性菌20株，構(gòu)成比為43.48%；真菌7株，其構(gòu)成比為15.22%。其中3例患者為混合感染，2例患者培養(yǎng)出兩種致病菌，1例患者培養(yǎng)出三種致病菌。 （7）主要的革蘭陽性菌對利奈唑胺、替考拉寧、萬古霉素的耐藥率最低，均為0；其次為呋喃妥因、阿米卡星，分別為7.14%、14.29%；青霉素、苯唑西林的耐藥率分別為63.16%、71.43%，紅霉素的耐藥率最高為72.22%。革蘭陰性菌中未發(fā)現(xiàn)對阿米卡星、亞胺培南、頭孢哌酮耐藥的菌株；對頭孢他啶、阿莫西林（克拉維酸）的耐藥率分別為20%、35.29%；氨芐西林的耐藥率最高，為81.25%。 （8）腹膜炎組50例患者共有3例死亡，7例拔管改做血液透析，其余患者均治愈，CAPD的退出率為14%，其中，本研究中7例真菌性腹膜炎，4例拔管改血液透析，3例死亡。 （9）真菌性腹膜炎患者PD的時(shí)間明顯長于G+及G-性腹膜炎患者；血白細(xì)胞數(shù)亦明顯高于兩種細(xì)菌性腹膜炎患者(P0.05)；G-菌性腹膜炎透析液白細(xì)胞數(shù)明顯低于G+菌性腹膜炎病例(P0.05)。 結(jié)論 1.營養(yǎng)差、貧血、電解質(zhì)紊亂是腹膜炎的易感因素。 2.腹膜透析相關(guān)性腹膜炎致病菌：革蘭陰性菌的構(gòu)成比為43.48%，革蘭陽性菌的構(gòu)成比為41.30%，真菌的構(gòu)成比為15.22%。 3.腹膜炎患者在經(jīng)驗(yàn)治療中，抗生素可繼續(xù)使用萬古霉素和頭孢他啶，頭孢唑林的耐藥率增高。 4.真菌性腹膜炎有較高的死亡率及退出率。
[Abstract]:PD is accepted by more and more people because of its own characteristics and superiority . With the continuous normalization of treatment , the incidence of peritonitis is significantly decreased , but it is the most common complication of peritoneal dialysis .

Purpose

The clinical data of continuous ambulatory peritoneal dialysis ( CAPD ) - related peritonitis in the first hospital of Jilin University was analyzed retrospectively , and the general clinical characteristics , pathogenic bacteria spectrum and drug resistance rate of peritonitis were summarized , which provided clinical basis for the treatment of peritonitis .

data and methods

From June 2011 to June 2013 , the patient of peritoneal dialysis - related peritonitis in the first hospital of Jilin University was selected as the study object , which was classified as peritonitis group ;
At the same time , the CAPD patients who didn ' t have peritonitis in the same period were selected as the control group , and the clinical data of the two groups were analyzed , and the clinical characteristics , flora distribution and drug resistance rate of peritonitis were discussed .

Results

( 1 ) There was no significant difference in the baseline data of age , sex , marriage , payment method , dialysis month and primary disease constitution of the two groups .

( 2 ) The number of white blood cells in the patients with peritonitis was higher than that in the control group ( P0.01 ) . The proportion of neutrophils in the peritonitis group was higher than that in the control group ( P0.01 ) . The red blood cells , the hematocrit and the hemoglobin in the peritonitis group were lower than those in the control group ( P0.05 ) .

( 3 ) The levels of serum potassium , sodium , chlorine and calcium in the peritonitis group were lower than those in the control group ( P0.05 ) .
The phosphorus in the peritonitis group was lower than that of the control group , but there was no significant difference between the two groups ( P > 0.05 ) .

( 4 ) The levels of serum albumin in the peritonitis group were significantly lower than those in the control group ( P0.05 ) . The levels of serum albumin in peritonitis group were significantly higher than those in the control group ( P0.05 ) . The iron protein level in peritonitis group was significantly higher than that in the control group ( P0.01 ) .

( 5 ) There was no significant difference between peritonitis group and control group ( P > 0.05 ) .
There was no statistical difference between the two groups ( P > 0.05 ) .
The incidence of diarrhea / constipation in the peritonitis group was higher than that in the control group , and there was significant difference between the two groups ( P0.01 ) .
In the peritonitis group , the serum creatinine was lower than that of the control group , there was no significant difference between the two groups ( P0.05 ) , and the urea nitrogen in the peritonitis group was lower than that of the control group , but there was statistical significance between the two groups ( P0.01 ) .

( 6 ) Of the 57 cases of CAPD , 42 were positive , the positive rate was 73.68 % , and 46 strains were co - cultured . Among them , 19 strains were Gram - positive bacteria , 20 strains of Gram - negative bacteria and 43.48 % of Gram - negative bacteria .
Of the 7 strains , the proportion of 7 strains was 15.22 % . Among them , 3 patients were mixed infection , 2 patients developed two pathogenic bacteria , and one patient developed three pathogenic bacteria .

( 7 ) The drug resistance of the main Gram - positive bacteria to linezolid , teicoplanin and vancomycin was the lowest , all of them were 0 ;
The second was furacine , amikaine , 7.14 % and 14.29 % , respectively .
The drug resistance of penicillin and benazosin was 63.16 % , 71.43 % and 72.22 % , respectively .
The drug resistance rates of ceftazidine and amoxicillin were 20 % and 35.29 % , respectively .
The drug resistance rate of ampicillin was the highest , which was 81.25 % .

( 8 ) In the peritonitis group , there were 3 cases of death , 7 cases underwent hemodialysis and the rest were cured . The withdrawal rate of CAPD was 14 % . Among them , 7 cases of fungal peritonitis in the study , 4 out of extraction and hemodialysis , 3 cases died .

( 9 ) The time of PD in patients with fungal peritonitis was significantly longer than those in G + and G - peritonitis ;
The number of white blood cells was also significantly higher than that in the patients with bacterial peritonitis ( P0.05 ) .
The number of white blood cells of G - bacterial peritonitis was significantly lower than that in G + bacteria peritonitis ( P0.05 ) .

Conclusion

1 . Poor nutrition , anemia and electrolyte disturbance are the susceptible factors of peritonitis .

2 . The proportion of Gram - negative bacteria was 43.48 % , the proportion of Gram - positive bacteria was 41.30 % , and the proportion of fungi was 15.22 % .

3 . In patients with peritonitis , antibiotics can continue to use vancomycin and ceftazidine in the treatment of peritonitis , and the resistance rate of ceftizazole is increased .

4 . fungal peritonitis has a high mortality rate and withdrawal rate .

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R656.41;R692.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 唐勇;劉婕;;腹膜透析相關(guān)性腹膜炎致病菌的耐藥性分析[J];華西醫(yī)學(xué);2009年08期

2 陳香美;周建輝;;中國腹膜透析技術(shù)發(fā)展現(xiàn)狀與未來[J];中國實(shí)用內(nèi)科雜志;2013年06期

3 郭群英;陳林;陽曉;楊念生;馮敏;姜宗培;毛海萍;陳崴;余學(xué)清;;腹膜透析相關(guān)感染性腹膜炎致病菌及菌譜變化——單個(gè)腹膜透析中心15年回顧分析[J];中華腎臟病雜志;2006年12期

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