不同透析方式青中年透析患者的感染特征分析

Analysis of Infection Characteristics of Dialysis Patients with Different Dialysis Methods

目的探讨青中年慢性肾衰竭维持性透析住院患者营养丢失状况、合并感染的相关危险因素以及感染部位和病原菌情况。方法搜集2018年期间在笔者医院住院的维持性血液透析和腹膜透析青中年患者作为研究对象,统计这些患者的基本信息、住院时间、透析龄、透析频率、透析通路类型、原发病种类、是否合并感染及感染部位和实验室检测指标等信息,评估患者营养丢失情况,感染的主要危险因素及病原菌类型。结果血液透析患者血红蛋白及血清白蛋白高于腹膜透析患者。283例慢性肾衰竭维持性透析患者中共106例患者合并感染,总感染率为37.46%;其中血液透析患者感染发生率为36.11%,感染部位主要为呼吸道(66.67%)、导管相关(5.56%)和泌尿系(12.96%);腹膜透析患者感染发生率为38.85%,感染主要部位为呼吸道(40.35%)、腹膜(43.86%)和泌尿系(15.79%)。病原菌分析显示革兰阴性菌最多(52.27%),其次为革兰阳性菌(22.73%),此外还有真菌、抗酸杆菌、支原体及病毒感染,约占15.91%。主要病原菌为大肠杆菌、铜绿假单胞菌、金黄色葡萄球菌等。单因素分析显示,住院时间、贫血、低蛋白、肌酐、血钠、血镁、血磷是住院透析患者发生感染的危险因素。多因素分析发现,住院时间长、低蛋白血症及高磷血症是此类患者发生感染的独立危险因素。结论对住院患者研究发现,腹膜透析在营养物质及电解质离子流失方面较血液透析明显,血液透析患者和腹膜透析患者均易发生感染,住院时间长、低蛋白血症及高磷血症是透析患者发生感染的独立危险因素,主要感染病原体为革兰阴性菌。

Objective To explore the nutritional loss status、the risk factors related to the infection and the location and pathogens of the infection of the maintenance dialysis patients with chronic renal failure.Methods Patients with maintenance hemodialysis and peritoneal dialysis who were hospitalized in our hospital during 2018 were enrolled.The basic information,hospitalization time,dialysis age,dialysis frequency,type of dialysis pathway,type of primary disease,whether infection occurred,information on the infection site and laboratory test indicators were counted.And then we assessed the patient′s nutritional loss,the main risk factors for infection and the type of pathogen.Results Hemoglobin and serum albumin were higher in hemodialysis patients than in peritoneal dialysis patients.In all 283 maintenance dialysis patients with chronic renal failure,106 patients developed infection,and the total infection rate was 37.46%.The incidence of infection in hemodialysis patients was 36.11%,the main infection site was respiratory tract(66.67%),catheter related(5.56%)and urinary system(12.96%).The incidence of infection in peritoneal dialysis patients was 38.85%,and the main sites of infection were respiratory tract(40.35%),peritoneum(43.86%),and urinary system(15.79%).Pathogen analysis showed that Gram-negative bacteria were the most(52.27%),followed by Gram-positive bacteria(22.73%),in addition to fungi,acid-fast bacilli,mycoplasma and viral infections,accounting for 15.91%.The main pathogens are Escherichia coli,Pseudomonas aeruginosa,Staphylococcus aureus and the like.Univariate analysis showed that hospital stay,anemia,low protein,blood sodium,blood magnesium,and blood phosphorus were possible risk factors for infection in dialysis patients.Multivariate analysis found that long hospital stays,blood phosphorus and hypoproteinemia were independent risk factors for dialysis patients.Conclusion Research findings on inpatients,peritoneal dialysis is more obvious than hemodialysis in the loss of nutrients and electrolyte ions.Hemodialysis patients and peritoneal dialysis patients are both prone to occur infection.Long hospital stay,blood phosphorus and hypoproteinemia are independent risks of dialysis patients.And gram-negative bacteria were the main pathogens of the infection.