Moncrief-Popovich Catheter: Implantation Technique and Clinical Results
Moncrief-Popovich Catheter: Implantation Technique and Clinical Results
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Moncrief-Popovich 导管：植入技术和临床结果
DOI：
10.1177/089686089401403s11
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发表时间：
1994
影响因子：
2.8
通讯作者：
R. Popovich
中科院分区：
文献类型：
--
作者：
J. Moncrief;R. Popovich
持续非卧床腹膜透析(CAPD)的发展和广泛应用激发了人们对腹膜通路的新兴趣(1，2)。强调棘袋连接技术已成功降低腹膜炎的发生率(3)。然而，腹膜透析患者群体中的脱落发生率并没有随着腹膜炎发生率的降低而减少(图1)。持续的高辍学率让我们探讨了辍学的主要原因可能与感染有关，这些感染与标准通道未能在外皮肤表面和腹膜之间形成足够的细菌屏障有关。隧道内沿导管外表面出现细菌代谢产物(生物膜)的报告表明，细菌侵入这一关键部位是常见的(4，5)。这可能会导致腹膜炎的反复发作，只能通过多个疗程的抗生素暂时控制，并可能导致高脱落率。因此，记录的高脱落率可能归因于最初手术植入时隧道的侵入。在接受腹膜透析的患者中，出口部位和腹膜腔之间的细菌屏障的形成和维持对于腹膜通路是必不可少的。细菌从外部环境转移到腹膜腔可能通过三种机制发生：
T he development and general application of continuous ambulatory peritoneal dialysis (CAPD) has stimulated a new interest in peritoneal access (1,2). Emphasis on connection technology at the spike bagjunction has successfully reduced the incidence of peritonitis (3). There has not, however, been a reduction in the incidence of dropout in the peritoneal dialysis patient population associated with this reduction in the incidence of peritonitis (Figure 1). The continued high dropout rate led us to explore the possibility that the primary cause of dropout was related to infections associated with the failure of the standard access to form an adequate bacteriological barrier between the external skin surface and the peritoneal cavity. Reports ofbacterial metabolic products (biofilm) occurring along the external surface of the catheter, in the tunnel, suggest that bacterial invasion of this critical site is common (4,5). This may produce repeated episodes of peritonitis only temporarily controllable with multiple courses of antibiotics and may lead to high dropout rate. The documented high dropout rate may therefore be attributable to invasion of the tunnel at the time of the original surgical implantation. The development and maintenance of a bacteriological barrier between the exit site and the peritoneal cavity is essential for peritoneal access in the patient undergoing peritoneal dialysis. Transfer of bacteria from the external environment into the peritoneal cavity may occur through three mechanisms: