中华诊断学电子杂志
中華診斷學電子雜誌
중화진단학전자잡지
2014年
3期
206-209
,共4页
张宜明%刘雷%孟雪%魏明明%王栋%张昆%曲小菡%李新建
張宜明%劉雷%孟雪%魏明明%王棟%張昆%麯小菡%李新建
장의명%류뢰%맹설%위명명%왕동%장곤%곡소함%리신건
腹膜透析%腹膜炎%诊断%预后
腹膜透析%腹膜炎%診斷%預後
복막투석%복막염%진단%예후
Peritoneal dialysis%Peritonitis%Diagnosis%Prognosis
目的:探讨培养阴性腹膜透析相关性腹膜炎(CNP)的临床特征及治疗体会。方法2008年1月至2012年12月收治的腹膜透析相关性腹膜炎(PDAP)患者56例,回顾性分析 CNP 患者的病史、化验室指标、病原菌、治疗方式及转归,并与同期收治的革兰氏阳性(G +)球菌、革兰阴性(G -)杆菌腹膜炎进行分组比较。采用 SPSS 15.0软件包进行统计学处理,两组血清不同致病菌PDAP 患者血清血红蛋白、白蛋白水平及腹膜透析液白细胞计数采用均数±标准差表示,显著性比较采用 t 检验,治疗的疗效、近期抗生素使用史及合并症发生率的比较用χ2检验。结果56例 PDAP 中CNP 组21例,G +球菌组24例,G -杆菌组11例;CNP 组有较高的近期抗生素使用史(23.8%);3组患者在腹膜透析液白细胞计数[(2486.9±2576.4)×106/L,(3017.5±1979.4)×106/L,(2526.7±509.7)×106/L,F =0.185,P >0.05]、近期抗生素使用率(23.5%,4.2%,9.0%,χ2=4.48, P >0.05)、合并出口/皮下隧道感染(4.8%,4.2%,0%,χ2=0.5,P >0.05)方面均差异无统计学意义;CNP 组血红蛋白(78.2±11.9)g/L 最低,与 G +球菌组(89.5±16.5)g/L (LSD-t =11.26, P <0.05)及 G -杆菌组(89.1±15.8)g/L(LSD-t =10.95,P <0.05)比较,组间差异有统计学意义。CNP 组血白蛋白(25.1±4.1)g/L 最低,与 G +球菌组(31.5±7.5)g/L(LSD-t =6.32,P <0.05)及 G -杆菌组(32.5±6.7)g/L(LSD-t =7.31,P <0.05)组比较,组间差异有统计学意义(P <0.05)。在疗效方面,CNP 组患者有较低的完全治愈率(66.7%),较高的拔管率(9.5%)、复发率(23.8%),但3组间初始应答率(81%,87.5%,90.9%,χ2=1.68,P >0.05)、完全治愈率(66.7%,75.0%,81.8%,χ2=1.12,P >0.05)、拔管率(9.5%,4.2%,0%,χ2=1.4,P >0.05)、复发率(23.8%,8.3%,0%,χ2=4.42,P >0.05),差异无统计学意义。结论培养阴性腹膜炎的产生与近期抗生素使用无关,其有较重的营养不良;且完全治愈率低,拔管率及复发率均较高,提示其预后相对较差。
目的:探討培養陰性腹膜透析相關性腹膜炎(CNP)的臨床特徵及治療體會。方法2008年1月至2012年12月收治的腹膜透析相關性腹膜炎(PDAP)患者56例,迴顧性分析 CNP 患者的病史、化驗室指標、病原菌、治療方式及轉歸,併與同期收治的革蘭氏暘性(G +)毬菌、革蘭陰性(G -)桿菌腹膜炎進行分組比較。採用 SPSS 15.0軟件包進行統計學處理,兩組血清不同緻病菌PDAP 患者血清血紅蛋白、白蛋白水平及腹膜透析液白細胞計數採用均數±標準差錶示,顯著性比較採用 t 檢驗,治療的療效、近期抗生素使用史及閤併癥髮生率的比較用χ2檢驗。結果56例 PDAP 中CNP 組21例,G +毬菌組24例,G -桿菌組11例;CNP 組有較高的近期抗生素使用史(23.8%);3組患者在腹膜透析液白細胞計數[(2486.9±2576.4)×106/L,(3017.5±1979.4)×106/L,(2526.7±509.7)×106/L,F =0.185,P >0.05]、近期抗生素使用率(23.5%,4.2%,9.0%,χ2=4.48, P >0.05)、閤併齣口/皮下隧道感染(4.8%,4.2%,0%,χ2=0.5,P >0.05)方麵均差異無統計學意義;CNP 組血紅蛋白(78.2±11.9)g/L 最低,與 G +毬菌組(89.5±16.5)g/L (LSD-t =11.26, P <0.05)及 G -桿菌組(89.1±15.8)g/L(LSD-t =10.95,P <0.05)比較,組間差異有統計學意義。CNP 組血白蛋白(25.1±4.1)g/L 最低,與 G +毬菌組(31.5±7.5)g/L(LSD-t =6.32,P <0.05)及 G -桿菌組(32.5±6.7)g/L(LSD-t =7.31,P <0.05)組比較,組間差異有統計學意義(P <0.05)。在療效方麵,CNP 組患者有較低的完全治愈率(66.7%),較高的拔管率(9.5%)、複髮率(23.8%),但3組間初始應答率(81%,87.5%,90.9%,χ2=1.68,P >0.05)、完全治愈率(66.7%,75.0%,81.8%,χ2=1.12,P >0.05)、拔管率(9.5%,4.2%,0%,χ2=1.4,P >0.05)、複髮率(23.8%,8.3%,0%,χ2=4.42,P >0.05),差異無統計學意義。結論培養陰性腹膜炎的產生與近期抗生素使用無關,其有較重的營養不良;且完全治愈率低,拔管率及複髮率均較高,提示其預後相對較差。
목적:탐토배양음성복막투석상관성복막염(CNP)적림상특정급치료체회。방법2008년1월지2012년12월수치적복막투석상관성복막염(PDAP)환자56례,회고성분석 CNP 환자적병사、화험실지표、병원균、치료방식급전귀,병여동기수치적혁란씨양성(G +)구균、혁란음성(G -)간균복막염진행분조비교。채용 SPSS 15.0연건포진행통계학처리,량조혈청불동치병균PDAP 환자혈청혈홍단백、백단백수평급복막투석액백세포계수채용균수±표준차표시,현저성비교채용 t 검험,치료적료효、근기항생소사용사급합병증발생솔적비교용χ2검험。결과56례 PDAP 중CNP 조21례,G +구균조24례,G -간균조11례;CNP 조유교고적근기항생소사용사(23.8%);3조환자재복막투석액백세포계수[(2486.9±2576.4)×106/L,(3017.5±1979.4)×106/L,(2526.7±509.7)×106/L,F =0.185,P >0.05]、근기항생소사용솔(23.5%,4.2%,9.0%,χ2=4.48, P >0.05)、합병출구/피하수도감염(4.8%,4.2%,0%,χ2=0.5,P >0.05)방면균차이무통계학의의;CNP 조혈홍단백(78.2±11.9)g/L 최저,여 G +구균조(89.5±16.5)g/L (LSD-t =11.26, P <0.05)급 G -간균조(89.1±15.8)g/L(LSD-t =10.95,P <0.05)비교,조간차이유통계학의의。CNP 조혈백단백(25.1±4.1)g/L 최저,여 G +구균조(31.5±7.5)g/L(LSD-t =6.32,P <0.05)급 G -간균조(32.5±6.7)g/L(LSD-t =7.31,P <0.05)조비교,조간차이유통계학의의(P <0.05)。재료효방면,CNP 조환자유교저적완전치유솔(66.7%),교고적발관솔(9.5%)、복발솔(23.8%),단3조간초시응답솔(81%,87.5%,90.9%,χ2=1.68,P >0.05)、완전치유솔(66.7%,75.0%,81.8%,χ2=1.12,P >0.05)、발관솔(9.5%,4.2%,0%,χ2=1.4,P >0.05)、복발솔(23.8%,8.3%,0%,χ2=4.42,P >0.05),차이무통계학의의。결론배양음성복막염적산생여근기항생소사용무관,기유교중적영양불량;차완전치유솔저,발관솔급복발솔균교고,제시기예후상대교차。
Objective To investigate the treatment experiences and clinic features of culture-negative peritonitis(CNP)in peritoneal dialysis (PD)patients.Methods CNP episodes were reviewed retrospectively in our medical center from January 2008 to December 201 2.The clinical manifestations, laboratory indicators,pathogenic bacteria,treatment,recovery rate,extubation rate,and relapse rate were analyzed and compared with those of gram positive and gram negative bacterial peritonitis.Comparing of curative effect,history of previous antibiotics treatment and the incidence of complications were analyzed by chi-squart test.Results Fifty-six patients with peritoneal dialysis-associateel peritonitis (PDAP) were reviewed.There were 21 cases with CNP,24 episodes with gram positive and 1 1 episodes with gram negative bacterial peritonitis in the 56 cases.CNP group had a much higher history of previous antibiotic treatment (23.8%).There were no significant differences in the white blood cell (WBC)count of dialysate (2486.9 ± 2576.4 ×1 06 /L,301 7.5 ±1 979.4 ×1 06 /L,2526.7 ±509.7 ×1 06 /L,F =0.1 85,P >0.05),history of previous antibiotic treatment (23.5%,4.2%,9.0%,χ2 =4.48,P >0.05 ),the combined infection of export/subcutaneous tunnel (4.8%,4.2%,0.0%,χ2 =0.5,P >0.05)of the three groups.CNP group had lower hemoglobin(78.2 ±1 1 .9)g/L,compared with gram positive group(89.5 ±1 6.5)g/L(LSD-t =1 1 .26,P <0.05 )and gram negative group(89.1 ±1 5.8)g/L(LSD-t =1 0.95,P <0.05),and there were significant differences among the three groups.At the same time,CNP group had lower serum albumin (25.1 ±4.1 )g/L,compared with gram positive group(31 .5 ±7.5)g/L(LSD-t =6.32,P <0.05)and gram negative group(32.5 ±6.7)g/L(LSD-t =7.31 ,P <0.05),and there were significant differences among the three groups.In the therapeutic effect,CNP group had lower complete cure rate(66.7%),higher catheter removal rate (9.5%),relapse rate (23.8%).There were no significant differences in overall primary response rate(81 %,87.5%,90.9%,χ2 =1 .68,P >0.05 ),the complete cure rate (66.7%, 75%,81 .8%,χ2 =1 .1 2,P >0.05),the catheter removal rate(9.5%,4.2%,0.0%,χ2 =1 .4,P >0.05) and relapse rate (23.8%,8.3%,0%,χ2 =4.42,P >0.05 )among the three groups. Conclusions The appearance of CNP may not be associated with history of previous antibiotic treatment. CNP has severe malnutrition,lower complete cure rate,higher catheter removal rate and catheter removal rate,suggesting a bad prognosis.