Peritonitis in Children being Treated with Continuous Ambulatory Peritoneal Dialysis

連續可攜帶性腹膜透析兒童之腹膜炎

邱元佑(Yuan-Yow Chiou) ； 陳偉鵬(Wei-Perng Chen) ； 楊令瑀(Ling-Yoeu Yang) ； CAPD小組(Capd Team) ； 林清淵(Ching-Yuang Lin)

《Acta Paediatrica Sinica》 36卷3期 (1995/06) Pp. 176-183

https://doi.org/10.7097/APS.199506.0176

摘要

自民國75年1月至82年12月間共有24位尿毒症患童於台北榮民總醫院小攻部接受連結可攜帶性腹膜透析(CAPD)治療，男女各半，年齡自2歲至17歲不等，平均追蹤時間爲639天（範圍爲50天至1882天）。發生腹膜炎之機率爲每人每15.2個月一次。其原因以操作技術汙染爲主因。微生物檢查結果爲培養之陽性率76.4%，格蘭氏陽性菌是主要致病菌，其中凝血酵素陰性葡萄球菌比率遠高於金黃葡萄球菌(32.4%，14.8%)。其臨床表現，僅約一半患童以典型症狀（發燒、腹痛、透析液混濁）表現，但88%之患童皆有透析液呈混濁之變化。治療上，當懷疑有腹膜炎時立即取樣檢查並於透析液中加入第一代頭芽苞抗生素或併用醣基胺基苷抗生素，再依透析液培養之結果更改。治療過程中，有52.9%患童需住院治療。且有一全因腹膜炎而死亡，另一例則死於併發之出血性胰臓炎，其餘皆治癒。治療中有四位患童需拔除透析管，其中兩例爲黴菌性腹膜炎。腹膜炎發生率和不同之透析管組分離系統有明顯之差異－手操作式分離系統(manual spike)約每人每4.6個月一次，明顯高於O-set（每人22.2個月一次）及UV-XD和Y-set兩系統。所有患童之血清白蛋白均維持於正常範圍，不受腹膜炎次數之影響。經分析統計發現：年齡、性別、CAPD換液之照顧者，或接受CAPD前之末期腎病治療時間之長短，皆非腹膜炎之危險因子。經由腹膜析平衡試驗結果顯示，有三次腹膜炎經歷以上者，其腹膜功能有下降之傾向（低於平均值）。所以爲使CAPD更能成爲適合尿毒症患童於換腎前更無缺點之治療方法，如何預防及減少腹膜炎之發生是必須的。

關鍵字

腹膜炎 ； 兒童 ； 連續可攜帶性腹膜透析

並列摘要

An eight-year retrospective study was performed to determine the incidence of peritonitis in a pediatric continuous ambulatory peritoneal dialysis (CAPD) population of 24 children, half of whom were boys and half girls. All suffered from end stage renal disease (ESRD). When these children, aged 2 through 17 years (mean: 10.7±3.8), were examined, the incidence of peritonitis was one episode every 15.2 patient-months. Microbiologic evaluation showed that 76.4% of the 34 episodes were culture positive, with Staphylococci species (coagulase negative staphylococci 32.4%, Staphylococcus aureus 14.7%) causing most cases especially early in dialysis. Half the patients presented with a triad of symptoms (fever, abdominal pain and cloudy dialysate), with cloudy dialysate was the major presentation (88%). Peritonitis was treated with intraperitoneal administration of cefacin and/or netromycin when suspected, and 52.9% of the episodes needed hospitalization. Except for two patients who died of complications (sepsis, acute pancreatitis), all episodes of peritonitis were cured; in four episodes it was necessary to remove a catheter, and two of those cases came from fungal peritonitis. Peritonitis rates differed among disconnect systems. The manual spike had peritonitis rate of one episode per 4.6 patient-months which was higher than the 0-set (one episode/22.2 patient-months), UV-XD and Y-set disconnect systems. Therefore, the major causes of peritonitis arose from contamination provoked by the technical aspect of the procedure. Nutrition status was stable in these patients. Serum albumin and total protein were adequate in all patients without relation to episode of peritonitis. According to a test of peritoneal equilibrium (PET), when patients experienced more than three episodes of peritonitis, PET decreased to low average. For CAPD to be a successful mode of therapy, the peritonitis rate must be decreased in the future.

並列關鍵字

peritonitis ； pediatric ； continuous ambulatory peritoneal dialysis