长期透析患者置管导管相关性感染的危险因素调查分析

Investigation and analysis of risk factors for catheter related infections in patients undergoing long-term dialysis

目的分析长期透析患者置管导管相关性感染的危险因素调查结果。方法 80例长期血液透析患者根据是否发生置管导管相关性感染分为感染组(n=35,感染39次)和未感染组(n=45)。回顾性调查分析两组患者的基本资料、部分实验室指标及可能引起导管感染的相关因素,并进行统计学分析。结果感染组共分离出病原菌39株,其中革兰阳性菌株占51.28%,革兰阴性菌株占48.72%。两组性别、疾病类型、心功能、血液透析龄、血肌酐、甘油三酯、血压、贫血情况等基础资料比较无统计学意义(P>0.05);但与未感染组相比,感染组高龄者、营养不良者、合并糖尿病者占比明显较高,血清血红蛋白、白蛋白水平明显更低,差异均有统计学意义(P<0.05),且两组置管导管留置时间、部位、置管次数及防护依从性比较差异显著(P<0.05)。Logisttic多因素回归分析显示,血清血红蛋白、白蛋白、营养不良、糖尿病、导管留置时间、导管留置部位、置管次数及防护依从性是维持性血液透析置管导管相关性感染的危险因素(P<0.05)。结论针对置管导管相关性感染的危险因素,如低血清血红蛋白和白蛋白、营养不良、糖尿病、导管留置时间长等,应采取有针对性地防治措施以避免或减少导管感染,提高血液透析的治疗效果。

Objective To analyze the risk factors for catheter related infections in patients undergoing long-term dialysis.Methods 80 patients undergoing long-term hemodialysis were divided into the infected group（n=35,39 times of infections）and the uninfected group（n=45）.The basic data,some laboratory indexes and catheter infections related factors were investigated retrospectively and analyzed statistically.Results 39 strains of pathogenic bacteria were isolated in the infected group,among which gram positive bacteria accounted for 51.28% and gram-negative bacteria accounted for48.72%.There were no significant differences between the two groups in basic data such as gender,type of disease,cardiac function,duration of hemodialysis,serum creatinine,triglyceride,blood pressure and anemia（P〉0.05）.Compared with the uninfected group,the proportions of elderly patients,patients with malnutrition and patients with diabetes mellitus were significantly higher,levels of serum albumin and hemoglobin were significantly lower in the infected group（P〈0.05）.There were significant differences between the two groups in catheter indwelling time,site,times of cathetering and protection compliance（P〈0.05）.Multivariate Logisttic regression analysis showed that serum hemoglobin,albumin,malnutrition,diabetes,catheter indwelling time,catheter indwelling site,times of cathetering and protection compliance were the risk factors for catheter-related infections in patients undergoing maintenance hemodialysis（P〈0.05）.Conclusion Targeted preventive measures should be taken according to the risk factors for catheter related infections such as low serum hemoglobin and albumin,malnutrition,diabetes and long catheter indwelling time to avoid or reduce catheter-related infections,and improve the therapeutic effect of hemodialysis.