Harwell C M, Newman L N, Cacho C P, Mulligan D C, Schulak J A, Friedlander M A
Department of Internal Medicine, University Hospitals of Cleveland, Ohio 44106, USA.
Perit Dial Int. 1997 Nov-Dec;17(6):586-94.
Peritonitis is considered an acceptable and controllable risk in patients undergoing chronic peritoneal dialysis (PD). In contrast, peritonitis due to visceral leakage represents a true "abdominal catastrophe" because of striking morbidity and mortality. To delineate the incidence, causes, and outcomes of catastrophic peritonitis, we compared patients who developed peritonitis due to documented visceral leakage with patients who developed peritonitis due to enteric organisms without evidence of visceral leakage.
Retrospective chart review.
PD Unit located in tertiary care referral center.
230 patients treated by PD between January 1988 and June 1996.
All episodes of PD-related peritonitis occurring over an 8-year period. Hospital course of all patients with or without renal failure who were treated at University Hospitals of Cleveland for ischemic bowel disease, cholecystitis, viscus perforation, or diverticulitis.
Anatomically documented visceral injury caused 32.5% of episodes of enteric bacterial peritonitis in 72 patients between January 1988 and June 1996. The overall incidence of this "abdominal catastrophe" was 11.3%, or 26 of a total of 230 patients treated by PD. Of the 26 patients, 50% died, 30.7% survived but switched permanently to hemodialysis, and only 19.2% remained on, or returned to, PD. Compared to renal failure patients treated by hemodialysis or transplantation and to non-renal failure patients, the incidence of abdominal catastrophe was 20-60 times greater in patients treated by PD.
Evidence for injury of an abdominal organ should be sought in all patients treated by PD who develop peritonitis with enteric organisms. Surgical intervention is definitive for diagnosis, and if performed early may reduce morbidity and mortality.
腹膜炎被认为是接受慢性腹膜透析（PD）患者可接受且可控的风险。相比之下，由于内脏渗漏导致的腹膜炎因具有显著的发病率和死亡率，堪称一场真正的“腹部灾难”。为了明确灾难性腹膜炎的发病率、病因及转归，我们将因有记录的内脏渗漏而发生腹膜炎的患者与因肠道细菌感染但无内脏渗漏证据而发生腹膜炎的患者进行了比较。
回顾性病历审查。
位于三级医疗转诊中心的腹膜透析单元。
1988年1月至1996年6月期间接受腹膜透析治疗的230例患者。
8年期间发生的所有与腹膜透析相关的腹膜炎发作情况。克利夫兰大学医院治疗的所有患有或未患有肾衰竭的患者，因缺血性肠病、胆囊炎、脏器穿孔或憩室炎的住院病程。
1988年1月至1996年6月期间，72例患者中，解剖学证实的内脏损伤导致32.5%的肠道细菌性腹膜炎发作。这种“腹部灾难”的总体发病率为11.3%，即230例接受腹膜透析治疗的患者中有26例发病。在这26例患者中，50%死亡，30.7%存活但永久转为血液透析，只有19.2%继续接受或恢复腹膜透析治疗。与接受血液透析或移植治疗的肾衰竭患者以及非肾衰竭患者相比，接受腹膜透析治疗的患者发生腹部灾难的发病率高20至60倍。
对于所有因肠道细菌感染而发生腹膜炎的腹膜透析患者应寻找腹部器官损伤的证据。手术干预对于诊断至关重要，早期进行手术干预可能降低发病率和死亡率。
