腹膜透析患者腹膜炎之病例對照研究

Peritonitis in Peritoneal Dialysis Patients: A Case-Control Study

腹膜透析（PD）是末期腎疾病常見處置之一。腹膜炎是PD嚴重合併症與死亡率至關重要。一旦引發腹膜炎合併症，不但導致PD導管被迫拔除，由PD轉血液透析治療，甚至危害患者生命安全。因此，本文旨在探討PD患者罹患腹膜炎之相關危險因子。本文利用醫院醫療資訊系統及病例對照研究（case-controlstudy）設計，收集南台灣某醫學中心某年度PD患者病歷資料。研究共收集207位符合研究條件之居家PD患者，其中38名（18.4%）患者曾至少被診斷一次（含）以上腹膜炎，將其歸類為「病例組」；其餘169（71.6%）人未曾被診斷腹膜炎的患者則歸類為「對照組」。以卡方或獨立T檢定分析人口學特徵、慢性病病史、實驗室檢查、患者居家透析自我照顧行為等資料，本研究結果發現：（一）病例組（有腹膜炎，n=38）與對照組（沒有腹膜炎，n=169）兩組，於年齡（P < .05）、個人經濟狀況（p < .001）、家庭經濟狀況（p < .001）、慢性病病史C型肝炎（p< .001）、充血性心衰竭（p < .001）、糖尿病（p < .05）等分佈上有顯著差異。（二）病例組比對照組有較高的透析導管出口處感染率，其比率分別為58%（n=22）與25%（n=42），P < .001。（三）對照組患者居家透析自我照顧行為總分顯著高於病例組（t=< .0001，p < .001），其得分分別為17.48±3.24與14.05±3.90。根據本研究結果建議，宜促進PD患者居家透析自我照顧行為，及早預防導管出口感染，同時處理C型肝炎、充血性心臟衰竭、糖尿病等健康問題，以降低PD腹膜炎的發生率。

Peritoneal dialysis (PD) is a widely used treatment for end-stage renal disease. Peritonitis is a critical complication of PD, significantly impacting mortality rates. Once complications of peritonitis occur, not only does it necessitate the removal of the PD catheter, leading to a transition from PD to hemodialysis treatment, but it also jeopardizes patient safety and even their life. Therefore, this study aimed to explore the associated risk factors for peritonitis in PD patients. This study utilized a hospital medical information system and a case-control study design to collect medical records data of PD patients from a medical center in southern Taiwan for a specific year. The study included 207 home-based PD patients who met specific criteria. Among them, 38 patients (18.4%) had a history of peritonitis, forming the ''case group,'' while the remaining 169 patients (71.6%) without peritonitis comprised the ''control group.'' With data analysis, including chi-square tests and independent t-tests, on demographic characteristics, chronic disease medical history, lab checkups, and home dialysis selfcare behaviors, the study results revealed that: (1) There were significant differences between the case group (with peritonitis, n=38) and the control group (without peritonitis, n=169) in terms of age (p < .05), personal economic status (p < .001), family economic status (p < .001), medical history of chronic diseases including hepatitis C (p < .001), congestive heart failure (p < .001), and diabetes (p < .05). (2) The case group had a higher rate of exit-site infections of the dialysis catheter compared to the control group, with rates of 58% (n=22) and 25% (n=42), respectively (p < .001). (3) The total score of home dialysis self-care behaviors in the control group was significantly higher than that in the case group (t=< .0001, p < .001), with scores of 17.48±3.24 and 14.05±3.90, respectively. Based on the study findings, it is recommended to promote home dialysis self-care behaviors among PD patients, to prevent exit-site infections of the catheter at an early stage, and to address health issues such as hepatitis C, congestive heart failure, and diabetes, in order to reduce the incidence of PD peritonitis.