Klaus G, Schäfer F, Querfeld U, Soergel M, Wolf S, Mehls O
Department of Pediatrics, University of Heidelberg, FRG.
Adv Perit Dial. 1992;8:302-5.
Relapsing peritonitis is often due to bacterial colonization of the Tenckhoff catheter and may require removal of the catheter in patients on peritoneal dialysis. The efficacy of a Tenckhoff catheter decontamination procedure was examined in 9 pediatric patients aged 1.5-18 years and compared to the outcome of a historical control group. After repeated dialysate cultures had become negative and cell count was normalized (< 100/ul), intraluminal urokinase (5000 IU/ml) and intraluminal high concentrated antibiotics (vancomycin, fosfomycin, cefotaxim) were instilled sequentially for 3 h and 1 h respectively. This procedure was performed once daily for three days. In addition, the connector was exchanged on the last day. This regimen prevented relapsing peritonitis in all study patients, whereas in the control group in 75.8% of events further relapses occurred, necessitating removal of the Tenckhoff catheter in 7/19 (36.8%) episodes. No side effects of intraluminal urokinase were recorded in any of the patients. We conclude that intraluminal urokinase and intraluminal high concentrated antibiotics combined with connector device exchange are highly effective for prevention of further relapses of peritonitis and reduce the need for Tenckhoff catheter exchange.
复发性腹膜炎通常是由于Tenckhoff导管的细菌定植引起的，对于接受腹膜透析的患者可能需要拔除导管。对9例年龄在1.5至18岁的儿科患者进行了Tenckhoff导管去污程序的疗效研究，并与历史对照组的结果进行了比较。在反复的透析液培养结果转为阴性且细胞计数恢复正常（<100/μl）后，依次向管腔内注入尿激酶（5000 IU/ml）和高浓度管腔内抗生素（万古霉素、磷霉素、头孢噻肟），分别持续3小时和1小时。该程序每天进行一次，共进行三天。此外，在最后一天更换连接器。该方案在所有研究患者中预防了复发性腹膜炎，而在对照组中，75.8%的事件出现了进一步复发，19例中有7例（36.8%）需要拔除Tenckhoff导管。所有患者均未记录到管腔内尿激酶的副作用。我们得出结论，管腔内尿激酶和高浓度管腔内抗生素联合连接器装置更换对于预防腹膜炎的进一步复发非常有效，并减少了Tenckhoff导管更换的必要性。
