伴有糖尿病的腹膜透析患者腹膜炎发生风险的队列研究

Cohort Study on the Risk of Peritonitis in Diabetes Patients on Peritoneal Dialysis

目的比较糖尿病腹膜透析患者与非糖尿病腹膜透析患者腹膜炎发生的临床特征及预后情况,针对其临床特征提出相应的护理对策。方法采用单中心、回顾性队列研究方法,分析2010年6月-2017年6月于上海交通大学医学院附属仁济医院腹膜透析中心行腹膜透析置管及持续不卧床腹膜透析治疗的患者临床资料。按照发生第一次腹膜透析相关性腹膜炎时患者是否确诊有糖尿病,将患者分为糖尿病组(n=30)及非糖尿病组(n=68)。比较两组患者的临床基本资料、临床营养代谢指标、血清C反应蛋白、血液生化指标、腹膜透析流出液致病菌病原学指标以及疾病预后指标。结果基本资料方面,与非糖尿病组患者相比,糖尿病组患者平均年龄较大(P<0.05);两组患者的透析操作者亦存在差异(P<0.05)。实验室检查方面,两组患者的血红蛋白、血清白蛋白、血清C反应蛋白、血磷、钙磷乘积均存在差异(P<0.05)。预后方面,糖尿病组患者有着更早发生腹膜炎的趋势(P<0.05),且其心血管疾病发生率、死亡率及因拔管导致结束腹膜透析的患者比例均高于非糖尿病组患者(P<0.05)。结论糖尿病腹膜透析患者更易发生感染及营养不良,且预后较非糖尿病患者更差。护理人员应加强对糖尿病腹膜透析患者的宣教,指导其积极预防腹膜炎。

Objective To compare the clinical characteristics and prognosis of peritonitis in diabetes patients on PD and non-diabetes patients on PD,thus to propose corresponding nursing countermeasures according to their clinical characteristics.Methods A single-center,retrospective cohort study was performed to analyze the clinical data of patients who underwent peritoneal dialysis and continuous ambulatory peritoneal dialysis at the Peritoneal Dialysis Center in Renji Hospital,Shanghai Jiao Tong University School of Medicine from June 2010 to June 2017.The patients were divided into diabetes group(n=30)and non-diabetes group(n=68)according to whether the patients were diagnosed with diabetes at the first occurrence of peritoneal dialysis-related peritonitis.The items compared between the two groups included clinical basic data,clinical nutritional and metabolic indicators,serum C-reactive protein,blood biochemical indicators,pathogenic bacteria etiological indicators of PD effluent and prognostic indicators.Results In terms of basic data,the average age of patients in the diabetes group was older than that in the non-diabetes group(P<0.05);there was also a difference in the dialysis operators between the two groups(P<0.05).In terms of laboratory tests,there were differences in hemoglobin,serum albumin,serum C-reactive protein,triacylglycerol,serum phosphorus and calcium-phosphorus product between the two groups(P<0.05).In terms of prognosis,patients in diabetes group had an earlier trend of peritonitis occurrence(P<0.05);their incidence and mortality of cardiovascular diseases,and proportion of patients who ended peritoneal dialysis due to extubation were higher than those in non-diabetes group(P<0.05).Conclusion Diabetes patients on PD are more likely to suffer infection and malnutrition,and have a worse prognosis than non-diabetes patients.The nurses should strengthen the propaganda and education to diabetes patients on PD and guide them to actively prevent perito nit is.