慢性肾功能衰竭血液透析患者发生医院感染的临床特点及相关危险因素分析

Clinical features of nosocomial infections in chronic renal failure patients who underwent hemodialysis and related risk factors

目的探讨慢性肾功能衰竭血液透析患者发生医院感染的临床特点及相关危险因素,为提高慢性肾衰竭患者血液透析的安全性提供参考。方法医院2008年1月-2009年1月收治的慢性肾功能衰竭行血液透析患者124例,按照是否发生医院感染分为:感染组75例和非感染组49例,将两组患者的资料、实验室诊断、医疗差异、住院环境等进行对比分析,总结慢性肾衰竭行血液透析患者发生医院感染的危险因素。结果两组患者血肌酐、甘油三酯及尿素清除指数,组间比较,差异均无统计学意义;感染组与非感染组各项资料分别为:年龄(66.4±11.5)岁、(54.3±15.5)岁,住院天数为(25.6±10.7)d、(14.7±14.3)d,白蛋白为(25.3±10.2)g/L、(36.1±11.3)g/L,血红蛋白为(77.4±13.4)g/L、(89.5±17.6)g/L,组间比较差异均有统计学意义(P<0.05);抗菌药物使用、病房环境、责任护士组间比较差异均有统计学意义(P<0.05);患者医院感染的好发部位为呼吸系统占43.6%、胃肠道占21.3%、导管感染占17.0%。结论慢性肾功能衰竭血液透析患者发生医院感染的危险因素,主要是患者自身及医疗因素;在治疗过程中,应加强医院感染控制管理,同时注意合理使用抗菌药物,尽量减少医院感染的危险因素。

OBJECTIVE To investigate the clinical features of nosocomial infections in patients with chronic renal failure who underwent hemodialysis and the related risk factors so as to provide reference for safe hemodialysis for the patients with chronic renal failure.METHODS A total of 124 patients with chronic renal failure who underwent hemodialysis from Jan 2008 and Jan 2009 were collected and divided into infection group（75 cases） and non-infection group（49 cases）,the general data,laboratory diagnostic data,medical differences,and hospitalized environment of the two groups of the patients were compared,the related risk factors for nosocomial infections in patients with chronic renal failure who underwent hemodialysis were summarized.RESULTS As compared with the general data of the two groups of patients,the differences in the serum creatinine,triglycerides,and KT/V were not statistically significant;the general data of the infection group and the non-infection group were respectively as follows：the age（66.4±11.5） years,（54.3±15.5） years,the length of hospital stay（25.6±10.7）d,（14.7±14.3）d,serum albumin（25.3±10.2）g/L,（36.1±11.3）g/L,and hemoglobin（77.4±13.4）g/L,（89.5±17.6）g/L,the differences between the two groups were statistically significant（P〈0.05）;as compared with the medical condition,the differences in the use of antibiotics,ward environment,and the responsibility of nurses were statistically significant（P〈0.05）;the most vulnerable site of nosocomial infections in patients was respiratory system,accounting for 43.6%,followed by gastrointestinal tract（21.3%）,catheter-related infections（17.0%）.CONCLUSION The risk factors for nosocomial infections in patients with chronic renal failure who underwent hemodialysis are mainly the individual factors and medical factors;it is necessary to strengthen the control of nosocomial infections as well as reasonable use of antibiotics in course of treatment so as to reduce the risk factorsfor nosocomial infections.