Goldraich I, Mariano M, Rosito N, Goldraich N
Department of Pediatrics, Hospital de Clínicas de Porto Alegre, Brazil.
Adv Perit Dial. 1993;9:325-8.
The interruption of chronic peritoneal dialysis for a period of time is recommended for replacement of the peritoneal catheter due to tunnel infection and/or relapsing peritonitis. In pediatric patients, in the younger ones, in particular, discontinuation of peritoneal dialysis can be problematic--there are difficulties associated with vascular access and hemodialysis. Over a 5-year period 9 children (4 infants, 2 preschool, 3 school-age) required 15 peritoneal access device replacements, without interruption of continuous ambulatory peritoneal dialysis (CAPD). The reasons for catheter replacement were tunnel complications (10), relapsing bacterial peritonitis (3), and fungal peritonitis (2). All catheter removals and placements were performed by surgical method under general anesthesia in a one-step procedure. The new catheters were implanted on the opposite side of the abdominal wall in all except one child, who had a colostomy. All patients received prophylactic antibiotics in the bags. In the postoperative period the patients infused smaller exchange volumes during 2 weeks. In the older children the exchange volumes were increased overnight. This schedule resulted in low intra-abdominal pressure. No patient required interval hemodialysis. Relapse of tunnel infection occurred in one episode in the first 2 months. We did not observe, in the same period, recurrence of peritonitis. One-step catheter replacement has been demonstrated to be safe; it avoids the disruption of ongoing treatment and promotes patient maintenance on CAPD.
由于隧道感染和/或复发性腹膜炎而需要更换腹膜导管时，建议中断慢性腹膜透析一段时间。在儿科患者中，尤其是年幼患者，停止腹膜透析可能会有问题——存在血管通路和血液透析方面的困难。在5年期间，9名儿童（4名婴儿、2名学龄前儿童、3名学龄儿童）需要更换15次腹膜通路装置，且未中断持续性非卧床腹膜透析（CAPD）。更换导管的原因是隧道并发症（10例）、复发性细菌性腹膜炎（3例）和真菌性腹膜炎（2例）。所有导管的拔除和置入均在全身麻醉下通过手术方法一步完成。除一名有结肠造口术的儿童外，所有新导管均植入腹壁的对侧。所有患者在透析液袋中接受预防性抗生素治疗。术后2周内患者输入较小的交换量。年龄较大的儿童交换量在夜间增加。这种方案导致腹内压较低。没有患者需要间歇性血液透析。在最初2个月内有1例发生隧道感染复发。在此期间，我们未观察到腹膜炎复发。已证明一步法更换导管是安全的；它避免了正在进行的治疗中断，并促进患者维持CAPD治疗。
