腹膜透析感染性合併症

Infectious Complications of Peritoneal Dialysis

腹膜透析合併症通常分為兩大類，一類為感染性，另一類為非感染性，非感染性泛指機械式併發症（mechanical complications）及代謝性異常（metabolic complications），例如注入和引流不順暢、滲漏、疝氣、電解質不平衡等，而感染性通常指的是腹膜炎（peritonitis）、導管出口／隧道發炎（exit site／tunnel infections）。針對感染性合併症綜觀臨床現況，腹膜炎仍是透析病患主要的合併症，且是決定透析治療成敗的關鍵。一旦發生感染時，小組成員應包括腎臟科醫師、護理師、營養師等共同召開檢討會議，且該小組成員應定期開會檢視所有腹膜透析相關感染並確認發生原因，經由不斷地改善降低感染機率。本文主要的目的是針對 2010 年國際腹膜透析協會（International Society for Peritoneal Dialysis, ISPD）所做的提議與筆者臨床實務作為分享，提供腹膜透析小組人員有所比較及遵循，藉此增進人員知己知彼，不斷改善，進而獲得更佳的醫療照護品質。

The complications associated with peritoneal dialysis can be categorized as noninfective or infective. Non-infective complications can be either mechanical or metabolic. Examples include catheter dysfunction, leakage, hernia, electrolyte imbalance, etc. Infective complications include peritonitis, exit site or tunnel infection. The most common complication of peritoneal dialysis is caused by peritonitis, and peritonitis is the critical determinant in successful peritoneal dialysis. A multi-disciplinary medical team comprised of a renal physician, nursing staff and dietician should therefore be set up as soon as possible to manage patients with peritonitis. The team should also meet regularly and review all the medical records to search for the cause and attempt to reduce the incidence of peritonitis. This article addresses clinical guidelines proposed by the International Society for Peritoneal Dialysis (ISPD) in 2010, reviews our past experiences with the treatment of peritonitis and attempts to provide guidance for peritoneal dialysis staff so better medical quality and outcomes can be achieved in the future.