老年患者血液透析相关感染的危险因素分析

Risk factors analysis of hemodialysis - associated infections in elderly patients

目的探讨老年患者血液透析相关感染的原因及特点，为其感染的预防和治疗提供理论依据。方法选取2012年1月-2014年6月在本院行血液透析治疗的老年患者60例。观察患者的年龄、血透龄、血红蛋白（HGB）、血浆白蛋白（ALB）、C反应蛋白（CRP）、血沉（ESR）、白细胞（WBC）、尿素清除指数（Kt／V）值等指标。使用COX回归分析老年患者透析相关感染的主要类型和相关危险因素，并以Kt／V和CRP水平对老年患者发生透析相关感染的诊断绘制ROC曲线。结果60例老年患者发生透析相关感染共78例次，其中肺部感染38例次（48．7％）、泌尿系感染20例次（25．6％）、消化道感染8例次（10．3％）、透析导管感染7例次（9．O％）、动静脉内瘘感染5例次（6．4％）；COX回归分析示：年龄、透析龄、Kt／V值、HGB、ALB、ESR、CRP水平与老年患者透析相关感染的风险存在显著相关性（P均〈0．05）；ROC曲线示：Kt／V和CRP水平与老年患者透析相关感染的关系密切。结论老年透析患者主要以呼吸系统、泌尿系统感染等最为常见。年龄、透析龄、Kt／V值、HGB、ALB、ESR、CRP等指标可能是引起透析相关感染的重要危险因素，定期监测Kt／V、CRP指标对透析相关感染有着较好的预防作用。

Objectives To investigate hemodialysis infection in elderly patients causes and , and to provide a theoretical basis for their infection prevention and treatment. Methods 6o cases were selected of hemodialysis treatment in the elderly patients in our hospital from January 2012 to June 2014. Observing all patients age, hemodial- ysis age and Hemoglobin （ HGB ）, serum al_bumin （ ALB ）, C reactive protein related indicators （ CRP ）, erythrocyte sedimentation rate（ ESR）, white blood cell（ WBC）, urea clearance index（Kt/V） values, etc. The main types and as- sociated risk factors were analyzed in elderly patients with various types of hemodialysis infection by COX regression analysis. To plot ROC curves according to Kt/V 和 CRP levels of various types of infection diagnosis for MHD elderly patients. Results There were 78 cases with dialysis - related infection happened in 60 cases of elderly patients. Of which 38 cases of pulmonary infection times （48.7 % ）, urinary tract infection 20 cases of times （25.6%）, gastrointes- tinal infection in 8 cases （ 10.3 % ）, dialysis catheter infection seven cases times （9.0%）, arteriovenous fistula infec- tion 5 cases（ 6.4% ） ; COX regression analysis showed .. age. duration of dialysis, Kt/V values, HGB, ALB, ESR, CRP levels in elderly patients with dialysis -related risk of infection was significantly correlated（ P 〈 O. 05 ） ;ROC curve shows： Kt/V 和 CRP levels closely related with hemodialysis infection in elderly patients. Conclusions The most common in main types of hemodialysis elderly patients infected were respiratory infections, urinary tract infec- tions. Age, hemodialysis age, Kt/V values ,HGB ,ALB ,ESR,CRP were relevant factors in hemodialysis patients in- fection. Kt/V 和 CRP levels would be an effective indicator to monitor hemodialysis elderly patients infections.