维持性血液透析肝病患者感染的临床研究

Clinical study of infections in liver disease patients undergoing maintenance hemodialysis

目的：了解维持性血液透析肝病患者发生感染情况，分析发生感染的因素，总结有效的防治措施，以降低临床感染率。方法选取1998年5月－2014年12月医院行维持性血液透析的肝病患者67例，采用回顾性调查方法对感染患者的年龄、感染部位分布及基础疾病等进行分析，使用SPSS15．0软件进行统计分析。结果67例患者中42例发生感染，感染率62．69％，其中患有慢性肾小球肾炎、糖尿病肾病、移植肾失功、多囊肾患者的感染率分别为57．50％、66．67％、100．00％、0；患有慢性乙型肝炎、慢性丙型肝炎、肝硬化患者的感染率分别为61．82％、66．67％、77．78％；感染部位以上呼吸道感染为主，占50．00％，其次为肺部感染和肠道感染，分别占38．10％和7．14％；感染患者以51～60岁最多，占52．38％，其次为61～70岁和41～50岁，分别占21．43％和14．29％；透析时间越长、肝功能越差，感染率越高。结论维持性血液透析合并肝脏疾病患者感染率较高，应加强基础疾病的治疗，增强机体抵抗力，规范操作流程，合理应用抗菌药物，以减少感染的发生。

OBJECTIVE To understand the prevalence of infections in the liver disease patients undergoing mainte‐nance hemodialysis ,analyze the risk factors for the infections ,and put forward effective prevention measures so as to reduce the incidence of clinical infections .METHODS A total of 67 liver disease patients who underwent the ma‐intenance hemodialysis in the hospital from May 1998 to Dec 2014 were enrolled in the study .By means of retro‐spective survey ,the age ,distribution of infection sites ,and underlying diseases of the patients with complicated infections were observed ,and the statistical analysis was performed with the use of SPSS15 .0 software .RESULTS The infections occurred in 42 of 67 patients ,with the infection rate of 62 .69% ;the infection rate was 57 .50% in the patients with chronic glomerulonephritis ,66 .67% in the patients with diabetic nephropathy ,100 .00% in the patients with transplanted kidney disease ,0 in the patients with polycystic kidney disease .The infection rate was 61 .82% in the patients with chronic hepatitis B ,66 .67% in the patients with chronic hepatitis C ,77 .78% in the patients with liver cirrhosis .Of the patients with infections ,50 .00% had the upper respiratory tract infections , 38 .10% had the pulmonary infections ,and 7 .14% had the intestinal tract infections .The patients aged between 51 and 60 years old were dominant among the patients with infections ,accounting for 52 .38% ,followed by the pa‐tients aged between 61 and 70 years old （21 .43% ） and the patients aged between 41 and 50 years old （14 .29% ） . The longer the dialysis time ,the poorer the liver function ,the higher the infection rate was .CONCLUSIONS The incidence of complicated infections is high in the liver disease patients undergoing the maintenance hemodialysis .It is necessary to strengthen the treatment of underlying disease ,intensify the immunity ,standardize the operation procedure ,and reasonably use antibiotics so as to reduce the incidence of infections .