血液透析与腹膜透析肾功能衰竭患者的感染特征及影响因素分析

Infection characteristics of the patients with renal failure treated with hemodialysis and peritoneal dialysis and its related factors

目的对比血液透析(HD)与腹膜透析(PD)肾功能衰竭患者的感染特征并分析其相关因素,为感染预防和控制工作提供客观依据。方法选取2015年6月-2017年6月于医院行透析治疗的257例慢性肾衰患者作为研究对象,根据透析方式分为PD组65例和HD组192例。对两组患者的感染情况进行观察和比较,检测比较两组患者感染相关样本中的病原菌分布,收集患者的年龄、性别构成、合并糖尿病、透析龄、体质指数(BMI)、血红蛋白(Hb)、血清白蛋白(ALB)等临床资料,采用单因素及多因素回归分析感染的相关影响因素。结果 257例患者中共176例发生感染,感染率为68.48%;PD组患者的感染率为36.92%低于HD组患者的79.17%(χ2=40.149,P<0.001);PD组患者共检出病原菌28株,少于HD组患者检出的176株(χ2=21.283,P=0.003);多因素分析结果显示,年龄≥60岁、合并糖尿病、透析龄<1年、Hb水平<10g/dL、ALB水平<3g/dL、具有深静脉置管、血液透析为肾功能衰竭透析患者感染的影响因素(P<0.05)。结论 PD患者和HD患者的感染部位和病原菌分布均具有一定的特征性,其感染风险与多种因素具有相关性,HD患者的感染率要高于PD患者,临床医生应给予密切的关注和及时的干预,以确保治疗效果、改善患者的预后。

OBJECTIVE To compare the infection characteristics between the patients with renal failure treated with hemodialysis（HD）and peritoneal dialysis（PD）and analyzed its related factors,so as to provide the objective basis for prevention and control of infections.METHODS A total of 257 cases of patients with chronic renal failure treated with dialysis from Jun.2015 to Jun.2017 were selected as the research subjects and divided into PD group（65 cases）and HD group（192 cases）according to the dialysis mode.The infection conditions of the patients in the two groups were observed and compared.The distribution of pathogenic bacteria in the infection related samples of the patients in the two groups were detected and compared.The clinical data of the age,gender,complication of diabetes,dialysis duration,body mass index（BMI）,hemoglobin（Hb）,and serum albumin（ALB）in the two groups were collected.Univariate and multivariate regression analysis were employed to analyze the related factors of infection.RESULTS Totally 176 cases were with infections in 257 patients,and the infection rate was 68.48%.The infection rate of the patients in PD group was 36.92%,which was lower than 79.17%in the patients in HD group（χ^2=40.149,P〈0.001）.Totally 28 strains of pathogenic bacteria were detected in PD groups,which was less than 176 strains detected in the patients in HD group（χ^2=21.283,P〈0.001）.The results of multi-variate analysis showed that the age≥60 years old,complication of diabetes,dialysis duration1 year,Hb level10 g/dL,ALB level3 g/dL,deep venous catheterization and dialysis mode were the influencing factors of the infections in the patients with renal failure treated with dialysis（P〈0.05）.CONCLUSION The infected sites and the distribution of pathogenic bacteria of PD patients and HD patients have certain characteristics.The risk is associated with a variety of factors.The incidence of the infections in PD patients is higher than that in HD patients.The clinicians should give close attentions and employ effective prevention to ensure the treatment effects and improve the prognosis of the patients.