中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2014年
1期
6-10
,共5页
腹膜炎%腹膜透析%治疗
腹膜炎%腹膜透析%治療
복막염%복막투석%치료
Peritonitis%Peritoneal dialysis%Treatment
目的 比较两种经验治疗方案(头孢唑啉联合三代头孢抗菌素与万古霉素联合三代头孢抗菌素)治疗腹膜透析(腹透)相关腹膜炎的疗效.方法 回顾性分析2008年1月至2012年12月期间在北京大学第一医院肾内科腹透中心接受规律腹透并发生腹膜炎患者的临床资料,根据经验治疗药物方案的选择分为A组(头孢唑啉联合三代头孢菌素)和B组(万古霉素联合三代头孢菌素),比较两组患者的临床表现特征和生化参数的差异,采用Logistic多元回归模型分析两种治疗方案对腹膜炎患者预后的影响.结果 共有233例腹膜炎患者(361例次)被纳入了研究,A组160例次(44.3％),B组166例次(46％),其他方案治疗组35例次(9.7％).B组患者发生腹膜炎前的血白蛋白[(33.5±6.0)比(35.3±5.2)g/L)]和胆固醇水平[(4.6±1.3)比(4.9±1.1) mmol/L]明显低于A组(P＜0.05).A组革兰阴性菌感染率略低,但差异无统计学意义(16.9％比24.7％,P=0.08).logistic多元回归分析结果提示不同经验抗菌方案不是预测治疗失败的独立危险因素[OR=1.07,95％ CI(0.45,2.56),P=0.87].结论 头孢唑啉和万古霉素均可作为腹膜炎经验治疗中覆盖革兰阳性球菌的首选抗菌素.
目的 比較兩種經驗治療方案(頭孢唑啉聯閤三代頭孢抗菌素與萬古黴素聯閤三代頭孢抗菌素)治療腹膜透析(腹透)相關腹膜炎的療效.方法 迴顧性分析2008年1月至2012年12月期間在北京大學第一醫院腎內科腹透中心接受規律腹透併髮生腹膜炎患者的臨床資料,根據經驗治療藥物方案的選擇分為A組(頭孢唑啉聯閤三代頭孢菌素)和B組(萬古黴素聯閤三代頭孢菌素),比較兩組患者的臨床錶現特徵和生化參數的差異,採用Logistic多元迴歸模型分析兩種治療方案對腹膜炎患者預後的影響.結果 共有233例腹膜炎患者(361例次)被納入瞭研究,A組160例次(44.3％),B組166例次(46％),其他方案治療組35例次(9.7％).B組患者髮生腹膜炎前的血白蛋白[(33.5±6.0)比(35.3±5.2)g/L)]和膽固醇水平[(4.6±1.3)比(4.9±1.1) mmol/L]明顯低于A組(P＜0.05).A組革蘭陰性菌感染率略低,但差異無統計學意義(16.9％比24.7％,P=0.08).logistic多元迴歸分析結果提示不同經驗抗菌方案不是預測治療失敗的獨立危險因素[OR=1.07,95％ CI(0.45,2.56),P=0.87].結論 頭孢唑啉和萬古黴素均可作為腹膜炎經驗治療中覆蓋革蘭暘性毬菌的首選抗菌素.
목적 비교량충경험치료방안(두포서람연합삼대두포항균소여만고매소연합삼대두포항균소)치료복막투석(복투)상관복막염적료효.방법 회고성분석2008년1월지2012년12월기간재북경대학제일의원신내과복투중심접수규률복투병발생복막염환자적림상자료,근거경험치료약물방안적선택분위A조(두포서람연합삼대두포균소)화B조(만고매소연합삼대두포균소),비교량조환자적림상표현특정화생화삼수적차이,채용Logistic다원회귀모형분석량충치료방안대복막염환자예후적영향.결과 공유233례복막염환자(361례차)피납입료연구,A조160례차(44.3％),B조166례차(46％),기타방안치료조35례차(9.7％).B조환자발생복막염전적혈백단백[(33.5±6.0)비(35.3±5.2)g/L)]화담고순수평[(4.6±1.3)비(4.9±1.1) mmol/L]명현저우A조(P＜0.05).A조혁란음성균감염솔략저,단차이무통계학의의(16.9％비24.7％,P=0.08).logistic다원회귀분석결과제시불동경험항균방안불시예측치료실패적독립위험인소[OR=1.07,95％ CI(0.45,2.56),P=0.87].결론 두포서람화만고매소균가작위복막염경험치료중복개혁란양성구균적수선항균소.
Objective To compare the efficacy of different antibiotics strategy,introperitoneal (IP) cefazolin plus third-generation cephalosporin versus IP Vancomycin plus thirdgeneration cephalosporin on peritoneal dialysis (PD)-related peritonitis.Methods All episodes of PD -associated peritonitis happened in prevalent PD patients between January 2008 and December 2012 were recruited from the PD Center of Peking University First Hospital.According to their empiric antibiotics scheme,episodes were divided into group A (where IP cefazolin plus third-generation cephalosporins were administrated) and group B (where IP Vancomycin plus third-generation cephalosporins were administrated).Multivariable logistic regression model was used to explore the influence of different emnpiric antibiotics scheme on peritonitis outcome.Results Patients in Group B had significantly lower level of serum albumin (33.5±6.0 vs 35.3±5.2 g/L) and cholesterol (4.6±1.3 vs 4.9± 1.1 mmol/L) than those in group A.In group A,the percentage of gram-positive bacteria was similar to group B (43.2％ vs 43.3％,P =0.96),but gram-negative bacteria was numerically lower (16.9％ vs 24.7％,P =0.08).Different empiric antibiotics strategy was not independent predictor of peritonitis outcome [OR =1.07,95％ CI(0.45,2.56),P=0.87].Conclusion Both cefazolin and vancomycin can be selected as first-line empiric antibiotic covering gram-positive organisms in the treatment of PD related peritonitis.
