Dasgupta M K
University of Alberta, Edmonton, Canada.
Adv Perit Dial. 1991;7:169-72.
In patients undergoing CAPD treatment, removal of peritoneal catheters has become a standard practice after two or more episodes of recurrent peritonitis which are refractory to antibiotic treatment. Immediate replacement of peritoneal catheters is not always safe in the presence of active peritonitis. Temporary institution of hemodialysis treatment in some of these patients may also be impossible because of unstable hemodynamic states or loss of vascular access sites. Successful continuation of CAPD treatment in some of these patients has been reported by using intraperitoneal (IP) administration of fibrinolytic agents such as streptokinase or urokinase as an adjunctive therapy to antibiotic treatment and as an outpatient procedure. Although numbers of cases reported are few in the literature and controlled studies in large numbers of patients are lacking, these reports emphasize the safety of IP use of these agents without any major systemic adverse effects. The reports are reviewed here to provide some practical guidelines for safe use of these agents in selected patients with recurrent CAPD-associated peritonitis.
在接受持续性非卧床腹膜透析（CAPD）治疗的患者中，在发生两例或更多例对抗生素治疗无效的复发性腹膜炎后，拔除腹膜导管已成为一种标准做法。在存在活动性腹膜炎的情况下，立即更换腹膜导管并不总是安全的。由于血流动力学状态不稳定或血管通路部位丧失，在这些患者中的一些人临时进行血液透析治疗也可能无法实现。据报道，通过腹腔内（IP）给予纤溶酶原激活剂，如链激酶或尿激酶，作为抗生素治疗的辅助疗法并作为门诊手术，这些患者中的一些人成功地继续进行了CAPD治疗。尽管文献中报道的病例数量很少，并且缺乏对大量患者的对照研究，但这些报告强调了腹腔内使用这些药物的安全性，没有任何重大的全身性不良反应。本文对这些报告进行了综述，为在选定的复发性CAPD相关性腹膜炎患者中安全使用这些药物提供一些实用指南。
