急性肾损伤患者血液净化导管相关性血流感染的因素分析

Related factors of blood stream infection associated with blood purification catheter in patients with acute kidney injury

目的探讨血液净化治疗的急性肾损伤(acute kidney injury,AKI)患者发生导管相关性血流感染的危险因素及其防治措施,旨在减少AKI患者血液净化治疗时导管相关血流感染事件的发生。方法回顾性分析912例行血液净化治疗的急性肾损伤患者的临床资料,采用单因素和多因素分析方法分析患者发生感染的相关因素。结果观察对象中发生导管相关性血流感染46例,血液净化的急性肾损伤患者导管相关性血流感染发生率为5.04%。是否感染患者在年龄、合并糖尿病、血红蛋白水平、白蛋白水平、插管次数、导管留置时间、健康知识评分方面差异有统计学意义(P<0.05),年龄>60岁(OR=1.732,95%CI:1.138~2.634)、合并糖尿病(OR=3.277,95%CI:1.428~7.524)、血红蛋白≤100 g/L(OR=2.335,95%CI:1.264~4.312)、白蛋白≤40 g/L(OR=3.196,95%CI:1.216~8.400)、插管次数>3次(OR=6.334,95%CI:2.036~19.704)、导管留置时间>15 d(OR=5.181,95%CI:1.702~15.773)是患者导管相关血流感染的危险因素(P<0.05),健康知识评分>80分(OR=0.611,95%CI:0.385~0.968)是患者导管相关血流感染的保护性因素(P<0.05)。结论血液净化治疗的急性肾损伤患者导管相关性血流感染发生率高,高龄、合并糖尿病、低血红蛋白、低白蛋白血症、多次置管和导管留置时间过长是其危险因素。临床应针对其危险因素积极做好防护工作,同时加强对患者的疾病健康宣教工作,以减少导管相关血流感染事件的发生。

Objective To explore the risk factors and prevention measures for catheter-related bloodstream infection in patients with acute kidney injury(AKI)treated with blood purification therapy,intending to reducing the incidence of catheter-related bloodstream infection events during hemodialysis in AKI patients.Methods Retrospective investigation and analysis were conducted on the clinical data of the 912 AKI patients treated with blood purification,and the influencing factors of infection were analyzed using univariate and multivariate regression analysis.Results In the observation subjects,46 cases of catheter-related bloodstream infection occurred,and the incidence of catheter-associated bloodstream infection in AKI patients was 5.04%.There were statistically significant differences in age,concomitant diabetes mellitus,hemoglobin level,albumin level,intubation frequency,duration of catheter and health knowledge scores in patients whether the infection occurred(P<0.05).The analysis showed that the age>60 years old(OR=1.732,95%CI:1.138~2.634),concomitant diabetes mellitus(OR=3.277,95%CI:1.428~7.524),hemoglobin≤100 g/L(OR=2.335,95%CI:1.264~4.312),albumin≤40 g/L(OR=3.196,95%CI:1.216~8.400),and intubation times>3times(OR=6.334,95%CI:2.036~19.704)and catheter indwelling time>15days(OR=5.181,95%CI:1.702~15.773)were risk factors of catheter-related bloodstream infection(P<0.05),and the health knowledge assessment score>80(OR=0.611,95%CI:0.385~0.968)were protective factors for patients with catheter-related bloodstream infection(P<0.05).Conclusions The incidence of catheter-related bloodstream infections in AKI patients treated with blood purification was high,and the older age,combined diabetes,hypohemoglobin,hypoalbuminemia,multiple catheter placements and prolonged catheter retention were risk factors.The clinic should actively protect itself against the risk factors and strengthen health education for patients about the disease to reduce the incidence of catheter-related bloodstream infections.