强化健康教育在腹膜透析相关性腹膜炎预防中的作用

Effect of reinforcement education on peritoneal dialysis-related peritonitis＇ prevention

目的探讨强化教育预防腹膜透析相关性腹膜炎的效果。方法纳入2006年1月至2009年12月在我院腹膜透析中心参加随访、CAPD〉3个月的991例患者。定期分析腹膜透析相关性腹膜炎危险因素的变化。运用成人教育理论，采用培训与复训、门诊随访、电话随访以及派发健康教育宣传资料等形式对患者进行预防腹膜透析相关性腹膜炎的强化教育。结果患者平均年龄（49．2±16．1）岁，男560例（56．5％），女431例（43．5％），腹膜透析持续时间3．0～170．9个月（中位数20．1个月），第一位原发病为肾小球。肾炎占59．2％。经过持续强化教育后，本中心腹膜透析相关性腹膜炎发病率由57．2个病人月，逐渐延长至61．3个病人月腹膜炎发病率下降。相比2006年，2009年因换液操作环节引起的腹膜炎所占比例下降（χ2=8．229，P=0．004），因出口处感染诱发的腹膜炎持续维持较低水平（〈5％），而因胃肠道问题引起的腹膜炎所占比例增加（χ2=9．720，P=0．002）。结论强化教育可以减少腹膜透析相关性腹膜炎的发生，尤其是因换液操作环节引起的腹膜炎发病率。因胃肠道问题引起腹膜炎的预防教育仍值得进一步关注。

Objective To explore the effect of reinforcement education on peritoneal dialysis-related peritonitis＇ prevention. Methods 991 patients who initiated continuous ambulatory peritoneal dialysis （CAPD） from January 2006 to December 2009 were recruited. The including standard was the duration on PD 〉 3 months. The changing of peritoneal dialysis-related peritonitis＇ causes was analyzed regularly. The reinforcement education about peritoneal dialysis-related peritonitis＇ prevention was carried out by using training and re- training, follow-up, telephone call, leaflet, etc. Results Patients＇ mean age was （49.2 ± 16.1 ）, male 56.5 % , female 43.5%, Peritoneal dialysis duration 3.0 -170. 9 months（ median 20. 1 months）, the primary renal disease was glomerulonephritis （ 59. 2% ）. After reinforcement education, the incidence of peritonitis was prolonging gradually （from 57.2 patient months to 61.3 patient months）. Comparing the causes of peritonitis in 2006, the proportion of dialysate connection＇ problems was significantly lower in 2009 （ X2 = 8. 229, P = 0. 004）, the proportion of exit-site infection＇ problems was low continuously in 2009 （ 〈5% ）, but the proportion of gastrointestinal problems was significantly increased （ X2 = 9. 720, P = 0. 002 ）. Conclusions Reinforcement education could reduce the incidence of peritoneal dialysis-related peritonitis, especially reduce the incidence of peritonitis due to dialysate connection＇ problems. The prevention education about peritonitis caused by gastrointestinal problems need to be investigated further.