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腹膜透析中腹膜炎的病理生理学及预防

Author
John M Burkart, MD
Section Editor
Thomas A Golper, MD
Deputy Editor
Alice M Sheridan, MD
Translators
王莉, 主任医师，教授

引言

腹膜炎是持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis, CAPD)的主要并发症之一，并且仍是患者从腹膜透析(peritoneal dialysis, PD)转为血液透析(hemodialysis, HD)的主要原因[1]。本专题将总结这种情况下导致腹膜炎的因素，并介绍降低这种并发症发病率的方法。

病理生理学与病因

PD相关的腹膜炎多由致病性皮肤细菌污染所致，其中绝大多数病例是由表皮葡萄球菌(Staphylococcus epidermidis)和金黄色葡萄球菌(Staphylococcus aureus)引起。 (参见“持续腹膜透析中腹膜炎的微生物学和治疗”)

在接受PD的患者中，完整的腹膜和间皮的防御机制可能是抵抗腹膜炎发生的最重要的屏障。与PD腹膜炎相关的全身性菌血症的发病率极低(<1%)；而据报道，手术性腹膜炎患者中全身性菌血症发病率则为30%[2]，而肝硬化伴腹水的自发性腹膜炎患者中则为39%-76%[3,4]。

即使患者已最大程度地掌握了透析技术，仍有多种因素会在这种情况下促成腹膜炎的发生：

●接受CAPD的患者通常会在一日之中多次与输液套件连接和分离，故而必须每年进行多次无菌性交换；在这种情况下，推测细菌性污染不常发生就是不合理的。相比之下，接受持续循环腹膜透析(continuous cycling peritoneal dialysis, CCPD)的患者需要与输液套件连接或分离的次数会少很多，故预计其腹膜炎发病率低于接受CAPD的患者。 (参见下文‘不同PD系统’)

                 

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Literature review current through: 2017-06 . | This topic last updated: 2016-01-28.
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