维持性血液透析患者并发感染的影响因素及预后调查

Investigation on influencing factors and prognosis of complicated infection in patients with maintenance hemodialysis

目的了解维持性血液透析(maintenance hemodialysis,MHD)患者并发感染的影响因素,了解MHD感染患者感染特点、预后情况以及影响预后的因素。方法收集贵阳市第一人民医院2012年1月至2017年12月住院的MHD患者资料,根据是否合并感染,将其分为感染组和非感染组。收集患者的一般资料和实验室检查结果,分析影响患者感染的因素,统计感染患者的病原菌及感染类型。根据MHD感染患者的预后情况分为预后良好组和预后不良组,分析影响患者预后的因素。结果通过对感染组及非感染组资料比较,发现原发病为糖尿病肾病、Kt/V<1.2、近3个月使用铁剂、血红蛋白<110 g/L、白蛋白<40 g/L的MHD患者发生感染的风险显著增加(P<0.05)。感染住院的MHD患者中,最常见的感染细菌有肺炎克雷伯杆菌、鲍曼不动杆菌、铜绿假单胞菌、金黄色葡萄球菌,其中呼吸系统感染最常见。通过多因素回归分析发现,影响MHD感染患者预后不良的因素有:年龄>65岁、卧床时间>10 d、需要输血、多重耐药菌感染、营养不良。结论原发病糖尿病肾病、Kt/V<1.2、近3个月使用铁剂、血红蛋白<110 g/L、白蛋白<40 g/L为MHD患者发生感染的危险因素;呼吸道感染最常见;年龄>65岁、卧床时间>10 d、需要输血、多重耐药菌感染、营养不良为MHD感染患者预后不良的危险因素。

Objective To know about influencing factors of complicated infection in patients with maintenance hemodialysis (MHD),and to understand characteristics,prognosis and influencing factors of complicated infection in patients with MHD. Methods Clinical data of MHD patients hospitalized in Guiyang First People’s Hospital from January 2012 to December 2017 were collected,and divided into the infection group and the non-infection group based on presence of complicated infection.General information and laboratory test results of these patients were collected,so as to analyze infectious factors in them and summarize types of pathogens and infections in them.Based on prognosis of these patients with MHD,they were divided into the good prognosis group and the poor prognosis group,so as to analyze influencing factors of their prognosis. Results Through comparison of the data between the infection group and the non-infection group,it was found that the risk for complicated infection increased significantly for those patients with a primary disease of diabetic nephropathy.Kt/V<1.2,and use of a ferric preparation,hemoglobin<110 g/L and albumin<40 g/L in recent 3 months ( P <0.05).In the MHD patients hospitalized due to infection,the most common infectious bacteria included Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa and,staphylococcus aureus,and infection of the respiratory system is the most common.Multi-factor regression analysis revealed that the factors influencing prognosis of complicated infection in the patients with MHD included age>65,bed time>10 days,requirement for blood transfusion,multiple drug-resistant bacterial infection,and malnutrition,with statistically significant difference ( P <0.05). Conclusions Primary diabetic nephropathy,Kt/V<1.2,and use of a ferric preparation,hemoglobin<110 g/L and albumin<40 g/L in recent 3 months are the risk factors of complicated infection in MHD patients;infection of the respiratory tract is the most common;and,age>65,bed time>10 days,requirement for blood transfusion,multiple drug-resistant bacterial infection and malnutrition are the hazardous factors of prognosis of complicated infection in patients with MHD.