腹膜透析基础推荐.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * Elaborate * Elaborate * * * * * * * * * * * * * Any new materials from Euro PD ? No but these references * * * * * * * * * * * * * * What if poor response  疗效欠佳时 If culture negative, step up the potency and spectrum coverage of antibiotics If culture available, adjust antibiotics accordingly Step up antibiotic therapy at D3 is appropriate Re-culture PDF, look for TB, fungus Removal of Tenckhoff catheter if poor response by D5-7 如果培养阴性, 抗生素升级，应用广谱抗生素 如果培养阳性, 根据药敏调整抗生素 在第3天抗生素换用更敏感的抗菌素 再次进行细菌培养, 寻找结核和真菌 如果5－7天后还无疗效，需考虑拔除腹透管 * If peritonitis subsided, is it OK? 腹膜炎好转后,是否治疗结束 Not so simple Quality management includes Identification of underlying cause Prevent recurrence 不是这么简单 质量管理包括 找出明确病因 防止复发 * Identifying underlying cause 明确根本原因 ESI and tunnel infection Inspect ES and tunnel, take culture if needed Check patient’s exchange technique Knowledge of peritonitis Home environment Take appropriate measures during exchange Any change in eye site or hand function Any change in bowel habits, 出口和隧道感染 检查出口和隧道, 必要时进行培养 检查病人的操作 了解腹膜炎知识 家庭环境 换液时采取适当措施 视力和手的功能有否改变 改变大便习惯，注意卫生 寻找病原和治疗应同时进行！ * Measures taken to prevent recurrence 预防再感染的措施 Act according to the cause identified Re-training Home visit Advise on dental hygiene, seeing a dental surgeon Advise on avoidance of straining bowel …. 根据病因采取不同措施 再次培训 家访 保持口腔卫生，建议至口腔科就诊 不要用力大便 …. * Minimization of peritonitis rate 使腹膜炎发生率降至最低 Generalization of the above action to other patients, e.g. Regular assessment of technique Regular re-training Education on dental hygiene Education on prevention of bowel straining 将上述的措施作为诊疗常规，例如： 常规检查腹透的操作 常规的再培训 口腔卫生的宣传 教育患者防止用力大便 * 1/5 of peritonitis episodes are associated with ESI/TI. Exit Site Infection 出口处感染 出口处菌落?出口处感染?隧道感染?腹膜炎?失去管路 Saureus: 金葡菌 Paeruginosa：假单胞菌 1/5腹膜炎与出口处感染相关 89%是常见细菌 （经验用药的依据） * Types of Exit Site Problems  出口处感染类型 Exit Site Infection - acute / chron