居家透析环境和腹膜透析相关腹膜炎发生史的关系研究

Home environmental factors and the history of peritonitis, a cross-sectional survey

目的 腹膜透析是一种居家透析治疗方式.本文旨在通过横断面研究探讨居家透析环境相关的因素是否和既往发生腹膜炎相关.方法 2011年5～8月共有266例临床稳定的腹膜透析患者参与此调查.采用自设问卷,调查患者居家透析环境,内容包括换液操作地点描述,紫外线照射、消毒剂擦拭房间的频率,家中是否养宠物等.8名经过培训的护士对患者进行了一对一的问卷调查.同时记录被调查患者的腹膜炎发生史和病原菌情况.结果 研究对象平均年龄60.1±13.6岁,女性151名占57.6％,糖尿病71例,占27.1％,平均透析龄38.7±28.5个月.有139例（53.1％）患者选择在独立的场所进行透析,123例（46.9％）的患者换液操作地点在卧室.紫外线消毒分别有33 （12.6％）,79 （30.1％）,150（57.3％）例患者达到低频、中频和高频.有41例（15.6％）患者承认在家中养宠物.透析龄长（RR=1.016,95％ CI 1.005～1.027,P=0.004）及在卧室透析的腹膜透析患者腹膜炎发生率更高（RR =1.841,95％ CI1.040～3.260,P=0.036）,而透析龄长（RR =1.015,95％ CI 1.001～1.029,P=0.040）和紫外线消毒频率低的患者感染表皮葡萄球菌或金黄色葡萄球菌腹膜炎的风险更高（RR=4.148,95％ CI 1.536～11.204,P=0.005）.结论 本研究观察到独立的操作空间,紫外线空气消毒频率和腹膜炎发生史的关系值得进一步研究.

Objective Peritoneal dialysis （PD） is a self-care mode at home,we therefore conducted a cross-sectional survey to explore whether home environment factors are associated with the history of peritonitis.Design Our study enrolled 266 prevalent patients,who were willing to be surveyed between May and August,2011.A self-designed questionnaire consisted of detailed description of location for bag exchange,the usage of ultraviolet radiation,the frequency of room cleaning with disinfectant,and the raised pets.Eight welltrained primary nurses completed the questionnaire in one-to-one way.The history of peritonitis and causative organisms was also recorded.Results The mean age of subjects was 60.1 ± 13.6 years,with 57.6％ of females and 27.1％ of diabetes patients.The dialysis duration was 38.7±28.5 months.The location for bag exchange was bed room in 123 （46.9％） patients,and was a separate room in 139 （53.1％） patients.During bag exchange,ultraviolet radiation performed with low,middle and high frequency in 33 （12.6％）,79 （30.1％） and 150 （57.3％） patients,respectively.The risk of peritonitis history was significantly higher in patients who had a long dialysis duration （RR=1.016,95％ CI 1.005～1.027,P=0.004） and performed bag exchange in bed room （RR=1.841,95％ CI 1.040～3.260,P=0.036）.The risk of peritonitis history caused by staphylococcus aureus or staphylococcus epidermidis was significantly higher in patients who had a long dialysis duration （RR=1.015,95％ CI 1.001 ～ 1.029,P=0.040） or used ultraviolet radiation in low frequency （RR=4.148,95％,CI 1.536～11.204,P=0.005）.Conclusions The association of peritonitis risk with location for bag exchange and frequency of ultraviolet radiation was observed and need to be further explored.