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目的:探讨化学性腹膜炎的临床表现,以提高对其的认识。方法:分析一例疑似头孢他啶引起的化学性腹膜炎的患者的诊治过程,并对化学性腹膜炎相关文献进行复习。结果:患者,6岁,诊断为慢性肾脏疾病(V期),予腹膜透析治疗,透析过程中出现感染性腹膜炎,予头孢他啶加入腹膜透析液中腹透,腹水白细胞下降,后复升,持续超过100×10~6/L,单核细胞比例在50%以上,无腹痛、腹水混浊等,停用头孢他啶后,腹水白细胞降至100×10~6/L以下,单核细胞比例降至50%以下。诊断头孢他啶引起的化学性腹膜炎可能。结论:化学性腹膜炎是一种极为罕见的情况,目前文献仅有报道戊二醛、万古霉素、艾考糊精可引起,且发病机制不详。在我们临床工作中,除了要考虑细菌、真菌等引起的感染性腹膜炎之外,还要考虑有无可能是其他因素包括:抗生素、赋形剂等所致的化学性腹膜炎。
Objective: To investigate the clinical manifestations of chemical peritonitis in order to enhance its understanding. Methods: The diagnosis and treatment of a case of chemical peritonitis caused by suspected ceftazidime were analyzed and the relevant literature on chemical peritonitis was reviewed. Results: The patient, aged 6 years, was diagnosed with chronic kidney disease (stage V) and was treated with peritoneal dialysis. Infectious peritonitis occurred during dialysis and ceftazidime was added to the peritoneal dialysis dialysate. The ascites leukocyte decreased and then rose for more than 100 × 10 ~ 6 / L, the proportion of monocytes in 50% or more, no abdominal pain, ascites and turbidity, disabled ceftazidime, ascites leukocytes down to 100 × 10 ~ 6 / L below the mononuclear cell ratio decreased to below 50% . Diagnosis of ceftazidime-induced chemical peritonitis may be. CONCLUSIONS: Chemical peritonitis is an extremely rare condition, and the current literature only reports that glutaraldehyde, vancomycin, and icodextrin can cause and the pathogenesis is unknown. In our clinical work, in addition to consideration of infectious peritonitis caused by bacteria, fungi, etc., it is also possible to consider other factors including: chemical peritonitis caused by antibiotics, excipients and the like.