腹膜透析患者导管外出口护理的现状调查

Current situation and influencing factors of exit-site care in peritoneal dialysis patients:a multicenter crosssectional survey

目的调查北京市和深圳市多所腹膜透析中心患者导管外出口护理的现状,并分析影响患者导管外出口护理行为的原因,为做好临床腹膜透析患者的培训提供依据。方法采用自制问卷对北京市及深圳市12所腹膜透析中心门诊随访的1204例腹膜透析患者的导管外出口护理情况进行调查。结果北京市和深圳市腹膜透析患者导管外出口护理得分为(44.76±5.85)分,导管外出口评估和无菌技术得分偏低。单因素分析显示,有无导管外出口感染史、不同换药操作者、不同导管外出口位置、不同文化程度、不同透析龄的患者导管外出口护理得分的比较,差异有统计学意义(P<0.05)。多元线性回归分析显示,影响导管外出口护理得分的因素为透析龄、导管外出口感染史、换药操作者、文化程度及导管外出口位置。结论腹膜透析患者导管外出口护理得分尚可,但导管外出口评估和无菌技术得分较低,仍需进一步加强培训,尤其是对透析龄长、有感染史的患者。

Objective To investigate the status of exit-site care among peritoneal dialysis patients through a multicenter survey in Beijing and Shenzhen,and to analyze the influencing factors of patients’exit-site care practice.Methods A self-designed questionnaire was used to investigate the exit-site care practice of 1,204 peritoneal dialysis patients who were followed up regularly in 12 peritoneal dialysis centers from Beijing and Shenzhen.The practice of exit-site care was divided into 5 dimensions:aseptic technique,assessment of exit-site,dressing change,catheter protection method and catheter fixation,with a full score of 50.Results The general score of exit-site care of 1,204 peritoneal dialysis patients in Beijing and Shenzhen was 44.76±5.85,while the scores of exit-site assessment and aseptic technique were relatively low.Univariate analysis showed that with or without history of exitsite infection,different operators and different locations of catheter outlet had different scores of exit-site care practice(P<0.05).Multiple linear regression results showed that the factors influencing the general score of exit-site care practice were dialysis duration,infection history,dressing change operator,patient education level and catheter outlet location with an order from high to low.Conclusion The practice status of exit-site care in peritoneal dialysis patients from Beijing and Shenzhen was generally acceptable,while the practice of exit-site care assessment and aseptic technique were relatively poor.Further retraining would be needed,especially for patients with long dialysis time and a history of infection.