Newman L N, Cacho C P, Schulak J A, Weiss M F
Department of Nursing, Division of Nephrology, University Hospitals of Cleveland, Cleveland, Ohio, USA.
Adv Perit Dial. 2001;17:93-7.
Abdominal catastrophe, defined as peritonitis from a visceral source, occurs in a significant number of patients treated by peritoneal dialysis. Peritonitis due to visceral injury is difficult to manage and is associated with high morbidity and mortality. Surgical intervention for both diagnosis and repair is definitive. However, no preventive strategy has been identified to date. The experience at University Hospitals of Cleveland and the published experiences of many other centers demonstrate that the risk of this complication has not changed in parallel with the many other improvements in the technique and outcome of peritoneal dialysis. We propose an approach to improve the understanding and outcome of this devastating complication. First, classification of peritonitis by source, not by organism, may lead to a more focused response to each episode of peritonitis. Second, the importance of antibiotic prophylaxis should be re-assessed in defined clinical settings that have a high likelihood of progressing to abdominal catastrophe. Third, optimal antibiotic regimens need to be devised and applied when visceral injury is highly suspected as a cause of peritonitis. Finally, the results of surgical interventions must be carefully studied.
腹部急症，定义为源于内脏的腹膜炎，在接受腹膜透析治疗的大量患者中发生。因内脏损伤导致的腹膜炎难以处理，且与高发病率和死亡率相关。手术干预进行诊断和修复是决定性的。然而，迄今为止尚未确定预防策略。克利夫兰大学医院的经验以及许多其他中心已发表的经验表明，这种并发症的风险并未随着腹膜透析技术和治疗效果的许多其他改善而同步改变。我们提出一种方法来提高对这种毁灭性并发症的认识并改善治疗效果。首先，按来源而非病原体对腹膜炎进行分类，可能会使对每一例腹膜炎发作的应对更加有针对性。其次，在进展为腹部急症可能性很高的特定临床环境中，应重新评估抗生素预防的重要性。第三，当高度怀疑内脏损伤是腹膜炎的病因时，需要制定并应用最佳抗生素方案。最后，必须仔细研究手术干预的结果。
