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中华肾病研究电子杂志 ›› 2018, Vol. 07 ›› Issue (02) : 49 -54. doi: 10.3877/cma.j.issn.2095-3216.2018.02.001

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腹膜透析相关腹膜炎的防治策略
阳晓1,(), 叶红坚1, 余学清1   
  1. 1. 510080 广州广东,中山大学附属第一医院肾内科
  • 收稿日期:2017-12-25 出版日期:2018-04-28
  • 通信作者: 阳晓
  • 基金资助:
    国家重点研发计划项目(2016YFC0906100); 国家自然科学基金(81774069,81570614)

Prevention and treatment strategies for peritoneal dialysis-related peritonitis

Xiao Yang1,(), Hongjian Ye1, Xueqing Yu1   

  1. 1. Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2017-12-25 Published:2018-04-28
  • Corresponding author: Xiao Yang
  • About author:
    Corresponding author: Yang Xiao, Email:
引用本文:

阳晓, 叶红坚, 余学清. 腹膜透析相关腹膜炎的防治策略[J]. 中华肾病研究电子杂志, 2018, 07(02): 49-54.

Xiao Yang, Hongjian Ye, Xueqing Yu. Prevention and treatment strategies for peritoneal dialysis-related peritonitis[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2018, 07(02): 49-54.

腹膜透析(腹透)是终末期肾病的有效替代治疗方法之一。然而腹膜炎仍然是腹透最常见的并发症,是导致腹透患者技术失败的主要原因。本文阐述了中国腹透相关腹膜炎流行病学特点;参照国际腹膜透析学会指南并结合作者所在腹透中心的经验,讨论了腹透相关腹膜炎的预防和治疗策略。

Peritoneal dialysis (PD) is one of the effective renal replacement therapies for end-stage renal disease (ESRD). However, PD-related peritonitis remains the most common complication of PD and the major cause leading to the technique failure of PD. This article focused on the epidemiological characteristics of PD-related peritonitis in China, and discussed the strategies of prevention and treatment for PD-related peritonitis by reference to the International Society for Peritoneal Dialysis (ISPD) guidelines as well as the experience from our PD center.

表1 不同病原体所致腹膜炎的后续治疗方案
病原体 代表菌 治疗方案 疗程 备注
初治有效 初治无效或耐药菌
凝固酶阴性葡萄球菌 表皮葡萄球菌[14] 第一代头孢类 万古霉素 2周,复发者疗程3周 如反复复发可予重新置管[37,38]
链球菌 草绿色链球菌 氨苄西林或一代头孢类 万古霉素 2周[39] 注意评估患者卫生问题
肠球菌 粪肠球菌 氨基糖甙类联合万古霉素[40,41] 利奈唑胺[42,43] 3周 常为难治性腹膜炎,注意评估患者肠道情况
金黄色葡萄球菌 金黄色葡萄球菌 第一代头孢类 万古霉素或替考拉宁[8] 3周 注意出口处或隧道感染,导管相关腹膜炎须拔管[4,44]
大肠埃希菌 大肠埃希菌 三代头孢类联合氨基糖苷类[45] 氨基糖苷类药物或亚胺培南和(或)西司他丁 3周 国内常见,治疗失败率和复发率高[16,46]
铜绿假单孢菌 铜绿假单孢菌 联合其中两种炎[47]:三代头孢类、喹诺酮类、氨基糖苷类 碳青酶烯类(厄他培南和美罗培南) 3周 评估出口处和隧道感染,导管相关腹膜炎须拔管
真菌性腹膜炎 白色念珠菌 改静脉用抗真菌治疗,病情改善后可改口服 氟康唑、卡泊芬净或伏立康唑 拔管后继续用药2周以上[8] 尽早拔除腹透导管[17,48,49]
分支杆菌 结核菌 改抗分支杆菌治疗 联合利福平、异烟肼、吡嗪酰胺和氧氟沙星[8,50] 吡嗪酰胺和氧氟沙星两个月后停,利福平和异烟肼持续十二月[8] 尽早拔除腹透导管
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