李 瑜,常颖忠,董 殷,李瑜琳

腹膜透析相关腹膜炎（Peritoneal Dialysis-associated Peritonitis，PDAP）作为诱发透析技术失败的核心并发症，其诊疗路径正经历从经验性干预向精准施治的深刻范式转换。本文全盘聚焦于PDAP临床管理的前沿新识，系统阐述其循证诊断、阶梯式抗感染体系及重症转归策略。在早期预警与确诊环节，临床须立足“三去二”循证基准采取“有罪推定”的急诊干预思维；鉴于致病微生态深刻受制于地域与气象学潮汐，亟需构建基于“时空异质性”的动态耐药预警模型以指导初始用药。在经验性与辅助干预维度，留取高质量标本后应即刻构筑兼顾革兰阳性与阴性菌的双重防线，经腹腔局部给药方案必须深度契合患者残余肾功能及不同透析模式的药代动力学特征；并前置性防范蛋白质-能量消耗及导管微血栓的形成。随着致病原及药敏图谱的破译，治疗需敏捷切换至降阶梯与目标导向干预，依据致病菌毒力将个体化疗程严格锚定于2至3周，并依托跨学科视角警惕继发性肠源性急腹症。针对复杂重症感染，现代质控体系引入“时间-病原学”二维矩阵以精准界定拔管干预阈值；面对难治性、复发性及真菌性事件，果断实施外科拔管以达成彻底的源头控制，配合序贯抗菌及严苛的模式重返评估，是阻断疾病向全身毒血症转归的关键止损抉择。综上所述，持续践行基于微生态变迁与数据驱动的规范化诊疗法则，必将大幅优化PDAP临床结局，进一步稳固腹膜透析作为终末期肾病一线替代治疗的战略核心地位。

腹膜透析；腹膜炎；经验性抗菌治疗；导管拔除；临床管理

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