Diaz-Buxo J A
Peritoneal Dialysis Services, Fresenius Medical Care, Charlotte, North Carolina, USA.
Adv Perit Dial. 1998;14:131-6.
The management of peritonitis in patients undergoing automated peritoneal dialysis (APD) deserves special consideration due to the technical differences between APD modalities and continuous ambulatory peritoneal dialysis (CAPD). The use of very short exchanges may preclude the prompt diagnosis of peritonitis by diluting the peritoneal-cell population and causing spuriously low cell counts and clear effluent. Very long diurnal cycles can have the opposite result and give a falsely elevated cell count. The effluent from the multiple automated exchanges must be visually examined before being discarded in order to make a prompt diagnosis. Direct drainage of effluent into the sewage without inspection should be avoided. If direct drainage becomes a common practice, other alternatives such as on-line cell counters or chemical detectors of possible infection will be necessary. The recommendations for antimicrobial therapy developed for CAPD apply as well to APD. If single-day dosage is to be used, the longer exchanges of APD are ideal for intra-peritoneal delivery of antibiotics.
由于自动腹膜透析（APD）模式与持续性非卧床腹膜透析（CAPD）在技术上存在差异，因此接受APD治疗的患者发生腹膜炎时的管理值得特别关注。采用极短的换液周期可能会稀释腹膜细胞群，导致细胞计数假性降低和引流液清澈，从而妨碍腹膜炎的及时诊断。而极长的日间周期则可能产生相反的结果，导致细胞计数假性升高。在丢弃多次自动换液产生的引流液之前，必须对其进行肉眼检查，以便及时诊断。应避免在未检查的情况下将引流液直接排入污水中。如果直接排放成为一种常见做法，那么就需要其他替代方法，如在线细胞计数器或可能感染的化学探测器。为CAPD制定的抗菌治疗建议同样适用于APD。如果要采用单日剂量给药，APD较长的换液周期对于腹腔内输送抗生素来说是理想的。
