慢性肾衰竭患者血液透析医院感染的临床特点及相关危险因素研究

Study of the clinical characteristics and related risk factors of nosocomial infections in patients with chronic renal failure receiving hemodialysis

目的总结慢性肾衰竭患者血液透析发生医院感染的临床特点,并分析其发生医院感染的相关危险因素,为降低慢性肾功能衰竭患者血液透析医院感染的发生率提供依据。方法将2009年1月-2011年12月收治的150例慢性肾衰竭血液透析患者为研究对象,其中发生医院感染90例(感染组),未发生医院感染60例(非感染组),采用SPSS13.0统计软件对比两组患者的临床资料,分析慢性肾衰竭患者血液透析发生医院感染相关危险因素。结果 150例慢性肾衰竭血液透析患者中,发生医院感染90例,感染率为60.0%,感染部位为呼吸系统、消化系统、导管感染及其他分别占44.5%、23.4%、16.0%及16.1%;感染组年龄、血红蛋白、血白蛋白、血清肌酐及尿素清除指数分别为(66.7±10.4)岁、(76.5±11.4)g/L、(25.2±11.3)g/L、(1.5±0.4)mmol/L、(1021±101)μmol/L及1.44±0.11,非感染组分别为(53.4±9.8)岁、(89.2±13.5)g/L、(36.3±10.6)g/L、(1.6±0.6)mmol/L、(1103±105)μmol/L及1.51±0.09;两组年龄、血红蛋白、血白蛋白比较,差异有统计学意义(P<0.05);感染组单人病房、责任护士执业>5年比例、住院时间及抗菌药物应用分别为11.1%、13.7%、(26.2±10.6)d及(88.3±4.5)次,非感染组分别为65.0%、81.7%、(14.3±9.3)d及(23.1±9.7)次;两组比较,差异有统计学意义(P<0.05)。结论慢性肾衰竭患者血液透析发生医院感染以呼吸、消化系统及导管感染为主,患者的年龄、Hb、ALB及医疗护理相关因素为其危险因素。

OBJECTIVE To summarize the clinical characteristics of nosocomial infection in patients with chronic renal failure receiving hemodialysis, and to analyze the risk factors associated with nosocomial infections, so as to provide the basis for reducing the incidence of nosocomiaI infection. METHODS A total of 150 patients with chron- ic renal failure and hemodialysis in our hospital from Jan. 2009 to Dec. 2011 were taken as the subjects of the study, of which 90 patients developed nosocomial infection （infection group）, and 110 patients with no nosocomial infection （non-infected group）. Clinical data of the patients in two groups were compared using SPSS 13.0 statisti-cal software. Also the risk factors associated with nosocomial infections were analyzed. RESULTS There were 90 patients developed nosocomial infections in 150 patients with chronic renal failure and hemodialysis, and the infec-tion rate was 60.0% The infection sites included respiratory system, digestive system, catheter-related infection and others, which accounted for 44.5% 23.4% 16.0%and 16.1%respectively. The age, HB, ALB, seruns creatinihe and urea clearance index of the infection group were （66.7±10.4） years old, （76.5±11.4） g/L, （25.2 ±11.3） g/L, （1.5±0.4） mmol/L, （1021±101） μmol/L, and 1.44±0.11, while in non-infection group were （53.4±9.8） years old, （89.2±-13.5） g/L, （36.3±-10.6） g/L, （1.6±-0.6） mmol/L, （103±105） %mol/L and （1.51±0.09）. The differences of the age, HB and ALB between the two groups were statistically significant （P 〈0.05）. The private room ratio in the infection group was 11.1 % and the ratio of nurse practitioners〉5 years was 13.7%, the hospital stay was （26.2±10. 6） days, and the use of antimicrobial drugs was （88.3±4.5） times, while in the non-infection group were 65.0%, 81.7%, （14.3±9.3） days and （23.1±9.7） times, respec-tively; the differences of the two groups were significant （P〈0.05）. CONCLUSION The nosocomial infections in patients with chronic renal failure receiving hemodialysis are mainly respiratory, digestive and catheter-related infections, and the age, HB, ALB and medical care of the patients are the related risk factors.