自体动静脉内瘘并发严重感染的临床分析

Clinical analysis of arteriovenous fistula related serious infection

目的通过总结近15年尿毒症患者发生内瘘感染的临床资料,探讨导致自体动静脉内瘘并发严重感染的原因,制定防治措施。方法选取1998年10月—2013年10月浙江省台州医院血液净化中心发生内瘘严重感染的患者,根据感染时机的不同,分成早期感染(内瘘手术后14 d以内)和后期感染(已经开始穿刺使用);对所有感染者的内瘘建立情况、使用过程、感染后的处理以及感染前后的体重、观察指标(血红蛋白、血浆白蛋白、总蛋白、总胆固醇)的变化进行详细分析。结果近15年有严重内瘘感染11例,年发生感染率为0.73%,有4例内瘘抗炎用药有效继续保留使用;6例因感染导致化脓、血管破裂严重内出血行手术清创+原内瘘结扎手术,再抗炎治疗2周后其中3例改近心端高位重建,3例改右颈内静脉带卡夫双腔导管;1例死亡。而感染前后的体重、部分观察指标差异有统计学意义(P<0.05)。结论早期感染可能为患者自身免疫力低下、手术时间过长、创伤过大,局部皮肤有炎症等;后期感染可能系钝针穿刺后隧道留细菌、消毒液过敏致皮肤瘙痒,抓痕,溃烂致感染以及穿刺口过早弄湿污染等;有针对性地预防和采取措施,可有效降低感染率,提升透析患者的生存质量。

To investigate the factors responsible for the arteriovenous fistula related infection, and provide theprevention and control measures. Methods A total of 11 patients with arteriovenous fistula infections in our center from Oct, 1998 to Oct,2013 were enrolled into this study andwere divided intoearly infection group（ within 14 days after the fistula opera- tion） and late infection group（ after the usage） according to the time of infection. The data of the patients with infections, including the fistula operation, usage process, treatment of infection, body weightof patients before and after the infection, blood hemoglobin, blood albumin, blood total protein and total cholesterol, were summarized and analyzed. Results The annum infection rate was 0. 73 %. Among the 11 patients,4 cases were able to fight infection effectively and keep using, 6 cases underwent surgical debridement and fistula ligation because of the formation of abscess or severe internal bleed- ing, and after two weeks of treatment with antibiotics, 3 of them had operations for high arteriovenous fistula, the rest of them were implanted long-term cuffed catheter through the right internal jugular vein, 1 case died. There were significant difference in weight and part of the test indexes （P 〈 0.05）. Conclusion The early infection may be due tolow immune function, long-time operation, severe trauma, local inflammation involving skin, and so on;the later infection may be due to the usage ofblunt needle puncture, disinfectant allergies can cause itchy skin, scratch, fester which could lead to infection, and so on. Taking effective measures to prevent and control can reduce infection rates and improve the quality of life of pa- tients with dialysis.