腹膜透析相關腹膜炎：臨床表現、診斷與治療

Peritoneal Dialysis-associated Peritonitis: Clinical Presentation, Diagnosis and Management

莊子逸(Tzu-I Chuang) ； 莊雅雯(Ya-Wen Chuang)

《內科學誌》 33卷4期 (2022/08) Pp. 261-273

https://doi.org/10.6314/JIMT.202208_33(4).02

摘要

腹膜透析相關腹膜炎（Peritoneal dialysis-associated peritonitis，簡稱PD peritonitis）是腹膜透析患者最常出現的併發症，可能導致病患需轉為血液透析、日後腹膜透析效率降低，嚴重者可能伴隨敗血症甚至死亡。腹膜透析人數在我國逐年上升，腹膜炎發生可能導致病人必須永久改為血液透析，對於患者日後生活品質有不良影響。與腹膜透析有關之腹膜炎分為感染性與非感染性，本文將聚焦於感染性腹膜炎，探討感染性腹膜炎的診斷、抗生素的選擇治療，決定何時移除腹膜透析導管以及預後。鑒於病原體的多樣性與異質性，抗生素的選擇對治療相當重要。尤其是在培養為陰性的病人，鑑別診斷更是相對不易。本篇文章的目的有三，首先論述腹膜透析腹膜炎之臨床表現、危險因子與診斷方式；其二，鑑別不同種類的病原體與腹膜炎之特徵；最後針對腹膜透析相關腹膜炎之治療方式做個別闡述。期望可及早診斷、減少腹膜炎相關併發症，促進腹膜透析患者之照護品質。

關鍵字

腹膜透析（Peritoneal dialysis） ； 感染性腹膜炎（Infective peritonitis） ； 臨床表現（Clinical presentation） ； 危險因子（Risk factors） ； 診斷（Diagnosis） ； 治療（Treatment）

並列摘要

Peritoneal dialysis-associated peritonitis (PD peritonitis) is the most prevalent complication among the patients with peritoneal dialysis. PD peritonitis may lead to the insufficiency of peritoneal dialysis, failure of peritoneal catheter, switch to hemodialysis, systemic infection or even death in severe cases. The number of peritoneal dialysis patients showed increasing trend in Taiwan. The growing number of the occurrence of peritonitis lowers the quality of life and threatens lives of patients with peritoneal dialysis. The prognosis of peritonitis depends on the accuracy of diagnosis, the choice of antimicrobial agents, and the decision on removal of peritoneal catheter. This review will focus on infectious peritonitis based on current literature and guidelines. The purpose of this review article is to discuss the manifestation, risk factors, and diagnosis of PD peritonitis; second, to differentiate the pathogens and corresponding treatment. We aim to diagnose the disease earlier, reduce the complications, and promote the quality of care for such patients with PD peritonitis.