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目的比较不同剂量万古霉素治疗耐甲氧西林金黄色葡萄球菌(MRSA)所致腹膜透析相关性腹膜炎的效果。方法选取2012年7月—2014年6月在我院进行治疗的MRSA所致腹膜透析相关性腹膜炎患者72例,随机分为A、B、C 3组,每组24例。3组患者均持续进行腹膜透析治疗,并给予万古霉素1 000 mg/L透析液负荷剂量进行治疗,之后A、B、C 3组患者分别给予万古霉素15 mg/L、25 mg/L、40 mg/L透析液维持剂量。观察3组患者临床疗效、治疗前后实验室检查结果 (透出液白细胞计数、透出液多核细胞百分比、血清C反应蛋白水平)及不良反应情况。结果 A组患者总有效率为79.2%,B组和C组患者均为91.7%,B组和C组总有效率均高于A组(P<0.05),而B组与C组总有效率比较,差异无统计学意义(P>0.05)。3组患者治疗前透出液白细胞计数、透出液多核细胞百分比、血清C反应蛋白水平比较,差异均无统计学意义(P>0.05);B组和C组患者治疗后透出液白细胞计数、透出液多核细胞百分比、血清C反应蛋白水平均低于A组(P<0.05),而B组与C组上述指标比较,差异无统计学意义(P>0.05)。治疗期间3组患者均未出现严重肝、血液系统损害等,C组有2例患者出现药物性皮炎。结论万古霉素25 mg/L透析液治疗MRSA所致腹膜透析相关性腹膜炎的效果较好,是相对安全、有效、经济的治疗方案,值得临床推广应用。
Objective To compare the effects of different doses of vancomycin on peritoneal dialysis-associated peritonitis caused by methicillin-resistant Staphylococcus aureus (MRSA). Methods 72 cases of peritoneal dialysis related peritonitis caused by MRSA in our hospital from July 2012 to June 2014 were randomly divided into A, B and C groups, 24 cases in each group. Peritoneal dialysis was continued in all 3 groups and vancomycin was administered at 1 000 mg / L dialysate. Patients in groups A, B and C received vancomycin 15 mg / L and 25 mg / L, respectively , 40 mg / L dialysate maintenance dose. The clinical efficacy, laboratory test results before and after treatment (white blood cell leaking out, percentage of infiltrating multinuclear cells, serum C-reactive protein level) and adverse reactions were observed in 3 groups of patients. Results The total effective rate was 79.2% in group A, 91.7% in group B and group C, and the total effective rate in group B and group C was higher than that in group A (P <0.05), while the total effective rate in group B and C The difference was not statistically significant (P> 0.05). There was no significant difference in the numbers of leukocyte, leukocyte infiltration, serum C-reactive protein in three groups before treatment (P> 0.05). The leukocyte count in patients in group B and group C (P <0.05). However, there was no significant difference between group B and group C (P> 0.05). Three groups of patients during the treatment did not appear serious liver, blood system damage, C group 2 patients with drug-induced dermatitis. Conclusion Vancomycin 25 mg / L dialysate is a safe, effective and economical treatment for peritoneal dialysis-related peritonitis caused by MRSA. It is worthy of clinical application.