目的分析铜绿假单胞菌腹膜透析相关性腹膜炎(PaeP)临床特征及转归。方法回顾性分析2019年1月—2020年12月某院肾脏内科门诊随访的腹膜透析相关性腹膜炎(PDAP)患者,根据细菌培养结果分为PaeP组和非PaeP组,分析PaeP患者的临床特征及铜绿...目的分析铜绿假单胞菌腹膜透析相关性腹膜炎(PaeP)临床特征及转归。方法回顾性分析2019年1月—2020年12月某院肾脏内科门诊随访的腹膜透析相关性腹膜炎(PDAP)患者,根据细菌培养结果分为PaeP组和非PaeP组,分析PaeP患者的临床特征及铜绿假单胞菌药敏试验结果,比较两组患者的临床表现、实验室检查结果及预后情况。结果共纳入腹膜透析患者124例,发生腹膜炎164例次,PaeP组16例,非PaeP组148例。铜绿假单胞菌感染11例,16例次,占PDAP患者的8.9%,其中4例患者伴腹膜透析置管隧道口感染,重现5例次,1例治愈,1例死亡,9例拔管。拔管患者中,1例停止透析,3例血液透析过渡后再次置管,5例永久转为血液透析(HD),技术失败率为54.5%。与非PaeP组比较,PaeP组患者透析时间较短(13.83±4.92 VS 38.53±35.77个月);感染期间C反应蛋白较高(96.61±66.17 VS 45.87±44.65 mg/L),清蛋白水平较低(25.62±4.42 VS 29.46±8.25 g/L);起始感染时腹膜透析液多核细胞比例较高;治疗第5天腹膜透析液白细胞计数转阴率较低;差异均有统计学意义(均P<0.05)。PaeP组患者治愈率低于非PaeP组,技术失败率高于非PaeP组,差异均有统计学意义(均P<0.05)。两组患者病死率比较,差异无统计学意义(P>0.05)结论PaeP患者临床表现较重,临床治疗效果差,重现率及拔管率高。对于反复重现的患者,拔管后重置并更换隧道,是降低技术失败的有效手段。展开更多
Internal herniation(IH)refers to the movement of intra-abdominal organs or tissues out of their original position through normal or abnormal orifices and fissures in the peritoneum or mesentery and into an anatomic sp...Internal herniation(IH)refers to the movement of intra-abdominal organs or tissues out of their original position through normal or abnormal orifices and fissures in the peritoneum or mesentery and into an anatomic space within the abdominal cavity.Although the incidence of small bowel obstruction(SBO)caused by IH is very low(approximately 0.2%to 0.9%),its incidence may be increased in certain specific populations or in postoperative patients.Recently Kaw et al shared their 13-year experience of managing IHs in a tertiary care hospital in India.This retrospective study analyzed and determined the clinico-demographic profiles,radiological and operative findings and postoperative course of patients with IH and the association with SBO.The results provide valuable insights into early diagnosis and establishment of a timely treatment regimen for this condition and emphasize the importance of combining rapid imaging evaluation with the traditional therapeutic approach of laparoscopic surgery,thus providing a novel perspective on the diagnosis and treatment of SBO caused by IH.展开更多
文摘目的分析铜绿假单胞菌腹膜透析相关性腹膜炎(PaeP)临床特征及转归。方法回顾性分析2019年1月—2020年12月某院肾脏内科门诊随访的腹膜透析相关性腹膜炎(PDAP)患者,根据细菌培养结果分为PaeP组和非PaeP组,分析PaeP患者的临床特征及铜绿假单胞菌药敏试验结果,比较两组患者的临床表现、实验室检查结果及预后情况。结果共纳入腹膜透析患者124例,发生腹膜炎164例次,PaeP组16例,非PaeP组148例。铜绿假单胞菌感染11例,16例次,占PDAP患者的8.9%,其中4例患者伴腹膜透析置管隧道口感染,重现5例次,1例治愈,1例死亡,9例拔管。拔管患者中,1例停止透析,3例血液透析过渡后再次置管,5例永久转为血液透析(HD),技术失败率为54.5%。与非PaeP组比较,PaeP组患者透析时间较短(13.83±4.92 VS 38.53±35.77个月);感染期间C反应蛋白较高(96.61±66.17 VS 45.87±44.65 mg/L),清蛋白水平较低(25.62±4.42 VS 29.46±8.25 g/L);起始感染时腹膜透析液多核细胞比例较高;治疗第5天腹膜透析液白细胞计数转阴率较低;差异均有统计学意义(均P<0.05)。PaeP组患者治愈率低于非PaeP组,技术失败率高于非PaeP组,差异均有统计学意义(均P<0.05)。两组患者病死率比较,差异无统计学意义(P>0.05)结论PaeP患者临床表现较重,临床治疗效果差,重现率及拔管率高。对于反复重现的患者,拔管后重置并更换隧道,是降低技术失败的有效手段。
基金Supported by the Chongqing Fundamental Research Funds,No.jbky20210001Performance Incentive-oriented Project of Chongqing,No.jxjl20220006。
文摘Internal herniation(IH)refers to the movement of intra-abdominal organs or tissues out of their original position through normal or abnormal orifices and fissures in the peritoneum or mesentery and into an anatomic space within the abdominal cavity.Although the incidence of small bowel obstruction(SBO)caused by IH is very low(approximately 0.2%to 0.9%),its incidence may be increased in certain specific populations or in postoperative patients.Recently Kaw et al shared their 13-year experience of managing IHs in a tertiary care hospital in India.This retrospective study analyzed and determined the clinico-demographic profiles,radiological and operative findings and postoperative course of patients with IH and the association with SBO.The results provide valuable insights into early diagnosis and establishment of a timely treatment regimen for this condition and emphasize the importance of combining rapid imaging evaluation with the traditional therapeutic approach of laparoscopic surgery,thus providing a novel perspective on the diagnosis and treatment of SBO caused by IH.
