终末期肾病血液净化住院患者医院感染探析

Hospital Infection Hospitalized Patients with End-stage Renal Disease Blood Purification

目的探讨终末期肾病血液净化住院患者医院感染危险因素及感染特点,为减少医院感染提供参考。方法回顾性分析2012年2月—2014年2月该院收治的200例终末期肾病透析患者临床资料,统计分析行血液透析和腹膜透析过程中发生医院感染事件。结果 200例住院透析患者64例发生医院感染,发生率32.0%;其中发生在呼吸道感染37例,占57.8%;血管通路感染18例,占28.1%。年龄>60岁、透析时间>6个月、留置导管时间>3 d、留置中心静脉导管时间>3 d、服用抗菌药时间>7 d和使用激素是诱发透析患者医院感染的主要危险因素。64例医院感染患者共检出病原菌65株,其中革兰阻性菌27例(41.5%),真菌21例(32.8%),革兰阳性菌17例(26.2%)。透析感染患者的血肌酐、C-反应蛋白水平均显著高于非感染患者(P<0.05),血浆白蛋白、血红蛋白水平均明显低于非感染患者(j2<0.05)。结论终末期肾病血液透析患者医院感染发生率高,其中医源性因素是诱发医院感染的高危因素。建议加强血液透析的监测和管理,针对性实施护理,减少医院感染,促进感染患者的预后。

Objective To investigate the hospital infection risk factors for hospitalized patients with end-stage renal disease blood purification and the infection characteristics, in order to reduce hospital infection to provide the reference. Methods A retrospec-tive analysis in February 2012 to February 2014, our hospital clinical data of 200 patients with end-stage renal disease on dialy-sis, and statistical analysis in the process of hemodialysis and peritoneal dialysis hospital infection happened. Results 200 cases of hospitalized dialysis patients, 64 cases of hospital infection, the incidence of 32.0%;which occurred in respiratory tract infection, 37 cases （57.8%）;Vascular access 18 cases of infection, accounting for 28.1%. Age 〉 60 years old, dialysis time 〉 6 months, in-dwelling catheter time 〉 3 d, central venous catheter indwelling time 〉 3 d, using antimicrobials time 〉 7 d and use of the hor-mone is a major risk factor for hospital infection induced by dialysis patients. 64 cases of hospital infection in patients with a total of 65 strains pathogenic bacteria detection of gram-negative bacteria 27 cases （41.5%）, fungus, 21 cases （32.8%）, gram-positive bacterium of 17 cases （26.2%）. Dialysis infection in patients with serum creatinine, C - reactive protein levels were significantly higher than patients without infection （P〈0.05）, plasma albumin, hemoglobin levels were significantly lower than the patients with-out infection （P〈0.05）. Conclusion The high incidence of end-stage renal disease patients with hemodialysis nosocomial infection, the doctor of traditional Chinese medicine source sex factors is to induce the risk factors of hospital infection. Suggest to strengthen the monitoring and management of hemodialysis, targeting nursing, reduce hospital infection, promote the prognosis of patients with infection.