腹膜透析相关性腹膜炎（PDAP）是导致腹膜透析技术失败甚至患者死亡的首要并发症，尽早获得准确有效的病原学鉴定结果指导抗感染方案是影响PDAP临床疗效的关键环节。本文系统回顾了广东省中医院腹透中心PDAP病原微生物检测方法及现状，在梳理国际临床实践指南和标准操作规程等临床证据的基础上，从“标本留取”“标本预处理”“培养条件”及“首次培养阴性处理”四个方面归纳总结了影响PDAP培养阳性率的技术要点和潜在改进措施；并以省中医腹透中心为示例，展示了如何结合现有临床证据，从患者宣教、多学科协作、标本处理等方面对单中心的PDAP标本处理及送检流程进行完善及优化，提供可行的单中心经验，供国内其他腹膜透析中心参考。

Context A Chinese herbal formula, Tiaopi Xiezhuo decoction (TXD), is developed from a classical Chinese prescription Sanhuang Xiexin decoction.Objective To investigate the regulatory effect of TXD on gut dysbiosis, as a treatment of constipation in patients with peritoneal dialysis (PD).Materials and methods The chemical content of TXD was assessed by high-performance liquid chromatography. A total of 29 PD patients were enrolled and treated with TXD orally (3 g crude drug/each/twice/day) for 3 months. Blood and faecal samples were collected at the beginning and end, to determine the changes in biochemical characteristics and gut microbial composition. The stool conditions were asked to be scored. Additional 30 healthy individuals were recruited as a control for the analysis of gut microbiota.Results Although having no significant effects on serum biochemical characteristics, 3-month TXD intervention improved constipation in PD patients: decreased 80% abdominal distention (p < 0.01), increased 2.6-fold sloppy stools (p < 0.05) and eliminated hard stool completely (p < 0.01). The analysis of gut microbiota showed that, compared to the healthy group, the microbial richness was reduced in PD patients. After a 3-month TXD treatment, this reduced richness was raised, and Paraprevotella clara, Lachnospiraceae bacterium 2-146FA, Phascolarctobaterium succinatutens, Lachnospiraceae bacterium 2-1-58FAA, Fusobacterium mortiferum, and Prevotella copri were accumulated in the intestinal flora. Furthermore, the bacterial species enriched by TXD correlated with the improvement of constipation.Discussion and conclusions TXD treatment may improve constipation by modulating gut dysbiosis in PD patients. These findings provide data to support the further application of TXD in the adjuvant treatment of PD.

Review question / Objective: The objective of the proposed work is to evaluate the efficacy and safety of moxibustion as a treatment in improving fatigue in dialysis patients.Condition being studied: Fatigue is a highly prevalent and debilitating symptom in patients undergoing dialysis and is associated with impaired quality of life, cardiovascular disease, and mortality.The causes of fatigue in patients receiving dialysis are complex and multifactorial.Uremia, anemia, depression, quality of sleep and physical deconditioning can lead to fatigue in dialysis patients.There is evidence suggested that specific non-pharmaceutical interventions were potentially effective in improving dialysis related-fatigue, such as cognitive behavioral therapy, exercise, reflexology, aromatherapy, acupressure and moxibustion.By far, how to relieve fatigue in dialysis patients remained controversial.

腹膜透析(peritoneal dialysis,PD)是终末期肾病(end stage renal disease,ESRD)患者常见的有效肾脏替代疗法之一[1].尽管PD技术目前已相对成熟,但维持性腹膜透析( maintenance peritoneal dialysis,MPD)患者的症状负担依然严重.据报告, MPD患者常伴有疲乏、瘙痒、食欲不振、营养不良、口干等症状[2～4] ,严重制约患者生活质量.既往研究显示,MPD患者口干发生率约为51. 8％ [4] ,口干会激发透析患者的饮水需要,易致其对限制饮水的依从性降低,从而増加死亡风险[5].目前,对于MPD患者口干症状的研究较为缺乏.本研究通过一项单中心横断面调查,探讨MPD患者口干相关影响因素及干预对策,以期有效地改善患者口干症状,提高患者生活质量.报道如下.

目的:水肿是慢性肾脏病患者较为常见的临床表现,本研究的目的是调查肾病患者水肿的发生情况及探索肾病水肿的相关风险因素.方法:我们回顾性收集于2017年9月-2018年8月期间在本中心住院治疗的肾病患者的临床资料,根据患者是否出现肾病水肿分为两组:非水肿组和水肿组,总结肾病患者水肿的发生率,并采用单因素和多因素逻辑回归分析影响肾病患者水肿发生情况的风险因素.结果:本研究共纳入417例肾病患者,平均年龄为(52.65±18.096)岁,男性比例为51.3％,肾性水肿发生率为48.7％.联合单因素和多因素逻辑回归分析表明原发病类型、血白蛋白水平、24h尿量、24h尿蛋白总量以及尿常规尿蛋白定性是肾病水肿发生的相关因素,其中原发病类型、血白蛋白水平、24h尿量、24h尿蛋白总量是肾病水肿发生的独立风险因素.结论:本研究结果表明肾病患者发生肾病水肿发生率高,血白蛋白和尿蛋白水平为肾病水肿发生的独立危险因素.这项研究提示临床医护人员应对肾病水肿的预防提高重视,同时为制定针对性强的治疗措施和宣教计划提供证据支持.

Aims: This study aimed to evaluate the long-term outcomes of peritoneal dialysis (PD) patients with and without diabetes in southern China. Methods: This retrospective and observational cohort study included all adult patients with end-stage renal disease (ESRD) who received PD in our center from January 2009 to December 2017 and were followed until December 2019. Clinical outcomes were compared by Kaplan?Meier survival analysis and cumulative incidence function, and risk factors were estimated using Cox regression analyses and competing risk models. Results: Of 401 patients receiving PD, 120 (29.9%) had type 2 diabetes mellitus (DM), and 281 (70.1%) did not have diabetes mellitus (NDM). Patients with DM were older and had more cardiovascular disease (CVD) morbidities than patients without DM. Kaplan-Meier analysis showed that patients with DM had shorter survival (Log-rank 3.215, P <0.0001) compared with patients without DM. Patients with DM had a lower death-censored technique survival (Log-rank 2.029, P = 0.0180), however, there was no significant difference in peritonitis-free period (Log rank 1.375, P = 0.1133). These results were reproduced after taking competing events into account. Both on multivariate Cox analysis and on multivariate competing risk regression, diabetes was an independent predictor for increased mortality and technique failure, but not for peritonitis-free survival. Conclusions: Patients undergoing PD with DM had increased risk of mortality and technique failure, and closer monitoring and additional focus in patients with DM treated by PD are, therefore, warranted. ? 2021 Elsevier Inc. All rights reserved.

腹膜透析( peritoneal dialysis,PD)是利用人体自身腹膜作为透析膜的一种透析方式,通过不断更新腹透液,达到肾脏替代或支持治疗的目的[1] ,具有血流动力学影响小、可居家操作等优点[2] ,是治疗终末期肾病( end-stage renal disease,ESRD)的主要肾脏替代疗法之一.既往研究显示:腹膜透析充分性达标的患者生活质量得到明显提高,生存期显著延长[3].准确评估PD患者的腹膜转运功能和尿素清除指数( Kt/V) ,实时调整透析方案,是保证透析充分性的关键所在.其中,评估患者每周Kt/V需要留取24 h腹透液标本,送往检验医学部检测尿素、肌酐水平.目前,国内外各大腹膜透析中心均根据各自经验进行24 h腹透液标本的留取,尚缺乏统一的方法.本研究拟对传统24 h腹透液标本留取方法进行改良,观察其采样结果与传统方法的一致性和护士采用两种方法的工作效率,为探讨建立科学、标准化的24 h 腹透液标本留取方法提供参考.具体报告如下.

Background: Fungal peritonitis (FP) is a rare but severe complication that can appear in patients receiving peritoneal dialysis (PD). This study aimed to investigate the incidence rate and clinical characteristics of FP, evaluate clinical outcomes between FP and bacterial peritonitis (BP) patients on PD, and especially estimate the risk factors for FP outbreak.Methods: All episodes of FP diagnosed in our hospital from January 1, 2011, to December 31, 2020, were reviewed in this single-center study. FP cases were analyzed and compared with patients diagnosed with BP in a 1:6 ratio matching for case-control study. Patient information, including clinical information, biochemical analysis, and outcomes, was recorded. Univariate and multivariate logistic regression model were used to analyze the risk factors for FP.Results: A total of 15 FP episodes were observed in 15 PD patients, with an FP rate of 0.0071 episodes per patient-year. Seventeen strains of fungi were isolated and identified. Candida was the most common pathogen (15 strains, 88.2%), followed by Aspergillus fumigatus (2 strains, 11.8%). Between the groups, FP group showed a higher rate of HD transfer and catheter removal, and a lower rate of PD resumption in the short-term outcome (all P < 0.01), while no significant difference in the mortality was noted during the whole study period. The multivariate logistic regression analysis showed that longer PD duration (odds ratio [OR] 1.042, 95% confidence interval [CI] 1.012–1.073, P < 0.01), higher serum potassium (OR 3.373, 95% CI 1.068–10.649, P < 0.05), elevated estimated glomerular filtration rate (eGFR) (OR 1.845, 95% CI 1.151–2.955, P < 0.05), reduced serum albumin level (OR 0.820, 95% CI 0.695–0.968, P < 0.05) and peritoneal effluent polymorphonuclear (PMN) count (OR 0.940, 95%CI 0.900–0.981, P < 0.01) were significantly increased the risk for FP.Conclusion: These results suggested that FP leads to higher rate of catheter removal and HD transfer, and a lower rate of PD resumption than BP, and that additional attention should be paid to hypoalbuminemia, increased serum potassium, long PD duration, and low peritoneal effluent PMN in PD patients.

目的 本研究旨在探索广东省名老中医黄春林教授“调脾泄浊方”对腹膜透析患者胃肠道症状的改善作用.方法 选取2017年12月至2018年12月在广东省中医院腹透门诊规律随访的维持性腹膜透析患者59例,随机分为中药组29例,对照组30例.中药组给予常规治疗+调脾泄浊方,对照组给予常规治疗+益生菌.观察两组患者的临床疗效,比较其胃肠道症状积分和中医证候积分结果,检测安全性指标,如实记录不良反应情况.结果 中药组患者的胃肠道积分和中医证候积分均显著下降,起到缓解腹胀、改善食欲以及软化大便等作用,并且未见不良反应.结论 与益生菌相比,“调脾泄浊方”对腹透患者胃肠道症状具有显著的改善作用.

Background Most end-stage renal disease (ESRD) patients undergo open surgical techniques for peritoneal dialysis (PD) catheter placement. An alternative method to PD catheter implantation is the half-percutaneous (“Half-Perc”) technique based on a modified trocar that is performed by a nephrologist. The single-center, retrospective, observational, cohort study presented here aimed to compare the effects of the “Half-Perc” technique with the traditional open surgery on peritoneal catheter insertion. Methods From January 2015 to January 2018, 240 ESRD patients who received initial PD catheter placement were divided into two groups based on the “Half-Perc” technique or open surgery. All patients were followed up for 365 days or until loss of initial PD catheter or death. Prism 5 software was used to analyze baseline characteristics, operation-related parameters, mechanical complications and clinical outcomes. Results The “Half-Perc” technique showed shorter operation time, shorter incision length, lower postoperative pain scores and quick initiation of the PD program compared to the open surgery. After the 365-day follow-up, the “Half-Perc” group showed a higher rate of catheter dysfunction (4% versus 0.9%) that was corrected by conservative treatment in most patients and a lower rate of peritonitis (4% versus 9.6%) but mechanical complications and clinical outcomes did not differ between the two groups. There was also no significant difference based on overall patient mortality or catheter removal. One-year initial catheter survival and true catheter survival were not statistically different between the groups. Conclusion The “Half-Perc” placement of the PD catheter using a modified metal trocar appears to be a non-inferior alternative method and carries minimal invasiveness and risk compared to open surgical placement.

Peritoneal dialysis (PD) catheter implantation is necessary for patients with end-stage renal disease (ESRD) to maintain continuous ambulatory PD (CAPD). In this study, we aimed to introduce a half-percutaneous technique based on a modified trocar device for the placement of a PD catheter and to evaluate the safety and efficacy of this technique and its associated short-term postoperative outcomes. Eighty-four ESRD patients who underwent PD catheter implantation with the half-percutaneous technique were recruited retrospectively between September 2016 and October 2017 from the Guangdong Provincial Hospital of Chinese Medicine. All catheter implantation procedures were performed by the same three nephrologists. The surgical protocol was described in detail, and the general intraoperative parameters and short-term complications were evaluated. All ESRD patients underwent successful PD catheterization with our novel technique. Neither conversion from this method to traditional open surgery nor major intraoperative complications were observed. The mean operative time was 20.8 ± 4.5 min, and the incision length was 2.28 ± 0.53 cm. The operative cost was CN ¥ 1762.45 (US $261), and the length of hospital stay was 7.5 ± 0.58 days. One patient (1.19%) showed leakage, and one patient (1.19%) experienced bleeding 2 weeks after the surgery. Catheter dysfunction due to catheter tip migration occurred in nine patients (10.7%) 2 weeks after the procedure, and the placement of the catheter was corrected with conservative treatment. No visceral injuries or PD-related infections were observed up to 4 weeks after the catheters were implanted. This half-percutaneous technique for PD catheter implantation appears to be a safe, effective and feasible procedure. This technique has the advantages of reduced surgical trauma, a shorter operative time and faster postsurgical recovery. In particular, this novel technique is easy for nephrologists to perform and therefore may help to promote and popularize PD treatment.

Objective To explore the effect of PDCA cycle in improving bacteria positive rate in peritoneal dialysis fluid.Methods This study was conducted in a historical control.A total of 76 peritonitis cases in the CAPD patients in the period from July 1,2016 to June 30,2018 were analyzed.31 patients not taking PDCA and included in the study from July 1,2016 to June 30,2017 were taken as a control group,while the study group (45 patients) were from July 1,2017 to June 30,2018,and received PDCA cycle on the basis of the control group.The bacteria positive rates of the two groups was compared.Results The bacteria positive rate in peritoneal dialysis fluid was 80.0％ in the observation group and was 64.5％ in the control group (x2=4.061,P=0.044).Conclusion PDCA cycle can effectively improve bacteria positive rate in peritoneal dialysis fluid.

腹膜透析( peritoneal dialysis,PD)是终末期肾脏病替代治疗的重要方式之一. 而心血管疾病一直是导致终末期肾病包括透析患者的最主要死因,高血压是发生心血管事件的一个主要危险因子,在PD患者中患病率高达65. 0％ ～87. 9％ [1,2] ,荟萃研究显示,对透析患者进行高血压治疗可降低心血管事件的风险,相对危险度(RR)为0. 69,95％CI为0. 56 ～0. 84[3]. 因此,控制血压对PD患者至关重要. 多项文献报道,患有高血压的透析患者中74. 4％ ～86. 0％接受降血压药物治疗,但仍有40. 0％ ～70. 0％控制不佳[4～6]. 我国血压控制现况亦欠佳,因此,中医自我管理参与降压具有重要意义. 本研究旨在探讨穴位按摩对腹膜透析高血压病人血压与症状的影响,从而为护理工作提供参考依据. 现报告如下.

腹膜透析(PD)是治疗终末期肾脏病的重要替代治疗方法之一,较血液透析而言,具有保护残余肾功能、治疗成本低、操作方便、无需体外肝素化、家庭和社会回归率高等优点,对心肺功能差、无法耐受血液透析、无法建立血管通路以及无条件行血液透析者,PD较为合适[1].PD通路是由PD导管(包括体内段、体外段)、钛接头和PD外接短管组成,PD通路的完好是PD正常进行的必备条件之一,然而随着PD时间的延长,任何原因引起的PD导管体外段、外接短管发生破裂渗漏,均可导致腹膜炎发生率的升高,重者可能需要退出PD治疗,其中部分甚至需给予拔除腹透导管并重新置管,不仅给患者带来痛苦且费用高,因此如何有效的预防导管、短管破裂渗漏、及时有效处理以及预防感染尤显重要,且目前PD发展迅速,国内各大小腹透中心逐渐建立发展,然而该并发症的发生率不高,目前针对病因、应急处理的报道尚少,且并无统一标准.