慢性肾脏病5期血液透析合并感染的临床分析与护理对策

Clinical analysis of stage 5 chronic kidney disease patients with infection during hemodialysis and related nursing measures

目的分析慢性肾脏病(CKD)5期血液透析患者合并感染的临床特点、感染相关因素以及具体护理对策。方法回顾性分析80例血液透析患者营养状况、免疫功能、原发疾病等因素与感染的相关性以及感染常见的部位和病原菌的种类,根据是否发生感染分为感染组(n=40)和非感染组(n=40)。结果感染组血清白蛋白(ALB)、血红蛋白(Hb)低于非感染组,血肌酐(Scr)和C反应蛋白(CRP)高于非感染组(P<0.05);合并感染患者原发疾病当中以慢性肾小球肾炎比例最高,其次为2型糖尿病和高血压肾损害;感染部位以肺部感染、血路感染多发;病原菌种以革兰氏阴性菌多见。结论应积极加强医疗护理,纠正贫血、加强营养、控制血糖和改善透析环境、规范操作等,减少透析患者感染发生风险。

Objective To analyze the clinical characteristics of stage 5 chronic kidney disease（ CKD） patients with infection during hemodialysis,and to investigate potential risk factors and related nursing countermeasures. Methods To retrospectively collected the nutrition status,immunologic function,primary disease of 80 stage 5 chronic kidney disease patients with hemodialysis treatment. Patients were assigned to the infection group（ n = 40） and Non-infection group（ n =40） according to the occurrence of infection during hemodialysis. The common site of infection and bacterial culture result of those with infection were analyzed. Results Patients in the infection group had lower level of serum albumin（ ALB） and hemoglobin（ Hb）,higher level of serum creatinine（ Scr） and C-reactive protein（ CRP） compared with those in the Non-infection group（ P〈0. 05）. In those patients with infection,chronic glomerulonephritis were most common primary disease,followed by type 2 diabetes mellitus and hypertensive kidney lesion. The pulmonary infection and blood related infection was two main infection sites. The bacterial culture result showed the gram-negative bacterium as main pathogenic bacteria. Conclusion It is necessary to carry out nursing measures on anemia correction,nutrition support,blood glucose control,environment of hemodialysis room,in order to reduce the risk of infection in stage 5 CKD patients during hemodialysis.