葛国军, 朱伯成, 吴婷婷, 徐赛亚, 楼柏炀, 王琳莉, 任文锂, 朱晓峰. 腹膜透析相关性丝状真菌腹膜炎拔管后重置1例并文献复习[J]. 临床肾脏病杂志, 2017, 17(1): 41-44. DOI: 10.3969/j.issn.1671-2390.2017.01.009
    引用本文: 葛国军, 朱伯成, 吴婷婷, 徐赛亚, 楼柏炀, 王琳莉, 任文锂, 朱晓峰. 腹膜透析相关性丝状真菌腹膜炎拔管后重置1例并文献复习[J]. 临床肾脏病杂志, 2017, 17(1): 41-44. DOI: 10.3969/j.issn.1671-2390.2017.01.009
    GE Guo-jun, ZHU Bo-cheng, WU Ting-ting, XU Sai-ya, LOU Bo-yang, WANG Lin-li, REN Wen-li, ZHU Xiao-feng. Re-intubation after extubation of peritoneal dialysis catheter in one case of peritoneal dialysis-related filamentous fungal peritonitis and review of literature[J]. Journal of Clinical Nephrology, 2017, 17(1): 41-44. DOI: 10.3969/j.issn.1671-2390.2017.01.009
    Citation: GE Guo-jun, ZHU Bo-cheng, WU Ting-ting, XU Sai-ya, LOU Bo-yang, WANG Lin-li, REN Wen-li, ZHU Xiao-feng. Re-intubation after extubation of peritoneal dialysis catheter in one case of peritoneal dialysis-related filamentous fungal peritonitis and review of literature[J]. Journal of Clinical Nephrology, 2017, 17(1): 41-44. DOI: 10.3969/j.issn.1671-2390.2017.01.009

    腹膜透析相关性丝状真菌腹膜炎拔管后重置1例并文献复习

    Re-intubation after extubation of peritoneal dialysis catheter in one case of peritoneal dialysis-related filamentous fungal peritonitis and review of literature

    • 摘要: 目的 报道腹膜透析相关性丝状真菌腹膜炎1例的诊疗过程及其预后,并结合文献复习以加强对该病诊疗方面的认识。方法 回顾性分析解放军第117医院收治的1例腹膜透析相关丝状真菌腹膜炎患者资料,并总结复习相关文献。结果 持续性不卧床腹膜透析的女性糖尿病患者,在出现腹膜透析相关性腹膜炎症状后,给予头孢他啶联合头孢唑林抗感染治疗15d,症状无明显改善;随后腹膜透析液培养提示丝状真菌,立即停用抗生素,给予氟康唑抗真菌治疗,并行腹膜透析管拔管术,术中腹膜透析管内奶酪样物质送检培养提示丝状真菌生长。患者拔管后行血液透析治疗,半年后重置腹膜透析管,行腹膜透析治疗,1.5%腹膜透析液4次/日;2周后测尿量650 ml,超滤量-490 ml,残肾尿素清除指数(Kt/V)0.811,腹膜Kt/V 1.832,总Kt/V 2.64/周,残肾内生肌酐清除率(endogenous creatinine clearance rate,Ccr)35.7,腹膜Ccr 38.9,总Ccr 74.6/周,氮表现率蛋白相当量1.12,提示透析充分,营养状况良好,PET试验提示高平均转运型。连续随访3年患者腹膜透析充分,后因无菌操作不规范致反复细菌性腹膜炎,最终诊断为腹膜超滤衰竭,退出腹膜透析,改行血液透析至今。结论 目前腹膜透析相关丝状真菌性腹膜炎治疗以拔管后退出腹膜透析为主,而在腹膜炎治愈、一般情况良好的条件下,仍可以考虑腹膜透析管重置。

       

      Abstract: Objective To study the diagnosis and treatment of peritoneal dialysis-related fungal peritonitis and its prognosis, combined with literature review, to strengthen the understanding of diagnosis and treatment of this disease.Methods We retrospectively analyzed the data of one case of peritoneal dialysis-related filamentous fungal peritonitis in the 117 th Hospital of PLA and reviewed the relevant literatures.Results A woman with diabetes receiving continuous ambulatory peritoneal dialysis (CAPD) was given ceftazidime combined with cefazolin in the emergence of peritoneal dialysis-related symptoms of peritonitis for 15 days, and there was no significant improvement in symptoms. The antibiotics were immediately withdrawn, the peritoneal dialysis tube was removed, and fluconazole was used when filamentous fungus was identified in peritoneal dialysis solution. The cheese-like substance in the intraperitoneal dialysis tube was cultured, and filamentous fungal growth was seen. Hemodialysis was performed after extubation. Six months later, the peritoneal dialysis catheter was re-intubated to do CAPD with 1.5% peritoneal dialysis fluid (4 times a day). Two weeks later, urine volume was 650 mL, ultrafiltration volume was -490 mL, residual kidney Kt/V was 0.811, peritoneal Kt/V was 1.832, total Kt/V was 2.64/week, residual kidney CCR was 35.7, peritoneal CCR was 38.9, total CCR was 74.6/week, and nPNAL was 1.12. PET test showed high average transport type. There was no severe symptom and patient was in good condition in the following 3 years. Repeated bacterial peritonitis occurred due to un-standardized aseptic operation. Then diagnosis of peritoneal ultrafiltration failure was made. Hemodialysis was given till now.Conclusions The main method of treating peritoneal dialysis-related filamentous fungal peritonitis is to withdraw peritoneal dialysis after extubation, however, when the peritonitis cured and the patient is in good condition, you can still consider re-intubation peritoneal dialysis catheter.

       

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