血液透析置管感染及防控对策研究

Study on Infection of Hemodialysis Patient and its Prevention and Control

目的探讨血液透析置管感染的相关因素并提出防控对策。方法选取温州医科大学附属第二医院血透室570例维持性血液透析(MHD)患者为对象,分析患者感染情况,对临床血液标本行病原菌培养与鉴定,分析置管感染相关因素,提出相应防控对策。结果570例MHD患者共发生63例置管感染,感染率为11.05%,其中隧道口感染38例,出口感染18例,导管定植5例,菌血症2例。血液培养检出79株病原菌,其中55株革兰氏阴性菌,23株革兰氏阳性菌,1株真菌。多因素Logistic回归结果显示,患者年龄、透析次数、导管置留时间、使用抗菌药物、血肌酐sCr≥1000μmol/L是血液透析置管感染的独立影响因素。结论MHD患者置管感染发病率较高,病原菌主要为革兰氏阴性菌,应针对感染因素采取有效预防措施,降低MHD患者置管感染发病率。

Objective To explore the related factors,prevention and control strategy of hemodialysis tube infection.Methods 570 patients with maintenance hemodialysis(MHD)in the hemodialysis room of the Second Affiliated Hospital of Wenzhou Medical University were selected as subjects.Infection status of patients was analyzed.Pathogenic bacteria were cultured and identified on clinical blood samples.Related factors of catheter infection were analyzed and corresponding prevention and control countermeasures were put forward.Results There were 63 cases of catheter infection in 570 MHD patients.The infection rate was 11.05%.There were 38 cases of tunnel mouth infection,18 cases of exit-site infection,5 cases of catheter implantation and 2 cases of bacteremia.79 pathogenic bacteria were detected in blood culture,including 55 Gram-negative bacteria,23 Gram-positive bacteria and 1 fungus.Multifactor logistic regression analysis showed that patients’age,dialysis times,catheter retention time,use of antibiotics and sCr≥1000μmol/L were independent influencing factors of catheter infection in hemodialysis patients.Conclusion The incidence of catheter infection in MHD patients is high,and the main pathogenic bacteria is Gram-negative bacteria.Effective preventive measures should be taken to reduce the incidence of catheter infection in MHD patients.