腹膜透析患者导管出口处护理实践对出口处感染的影响分析

Influence of exit-site care on exit-site infection in patients undergoing peritoneal dialysis

目的调查腹膜透析患者导管出口处(以下简称“出口处”)护理现状,分析出口处护理实践对出口处感染的影响。方法采用便利抽样的方法选取南方医科大学南方医院腹膜透析中心2019年1月—10月参加门诊随访的腹膜透析患者作为研究对象,采用出口处Schaefer评分表诊断患者是否发生出口处感染,根据国际腹膜透析协会的指南建议及相关文献制定腹膜透析患者出口处护理实践调查表,调查所有患者的腹膜透析出口处护理现状,采用logistic回归分析出口处护理实践对出口处感染的影响。结果共纳入208例腹膜透析患者,其中39例患者共发生43次出口处感染,感染率为0.06次/病人年;感染的细菌以金黄色葡萄球菌(30.2%)和铜绿假单胞菌(16.3%)为主;39例感染患者中,8例(20.5%)并发腹膜炎,3例(7.7%)发生1次以上感染。208例患者出口处护理评分为(3.14±2.75)分,其中204例(98.1%)接受过护士出口处护理培训,166例(79.8%)能按要求洗手、戴口罩,196例(94.2%)在导管出口处覆盖敷料,184例(88.5%)对导管进行固定,但关于涂抹抗生素软膏并未遵循最新指南要求。Logistic回归分析结果显示,出口处红肿史[比值比(odds ratio,OR)=7.926,95%置信区间(confidence interval,CI)(2.367,26.535),P=0.001]和牵拉出血史[OR=5.750,95%CI(1.878,17.610),P=0.002]是出口处感染的危险因素。结论腹膜透析患者出口处感染较常见,大部分患者能按护士要求进行出口处的护理,但护理内容与最新的指南存在一些差异。护理人员应根据指南改进培训内容,加强出口处评估、随访和再培训,及时处理出口处红肿情况,叮嘱患者注意导管固定、避免过度牵拉,预防出口处感染和进一步发展为腹膜炎。

Objective To investigate the status of exit-site care in patients undergoing peritoneal dialysis,and analyze the relationship between exit-site care practice and exit-site infection.Methods The patients undergoing peritoneal dialysis in Nanfang Hospital,Southern Medical University between January and October 2019 were recruited by convenience sampling method.The Exit-site Schaefer Scale was used to diagnose the occurrence of exit-site infection.According to the guidelines of the International Society of Peritoneal Dialysis and relevant research,a questionnaire was developed to investigate the status of exit-site care in all peritoneal dialysis patients.Logistic regression analysis was used to analyze the influence of care practice on exit-site infection.Results A total of 208 peritoneal dialysis patients were recruited.There were 39 patients with(totally 43 times of)exit-site infections,with an exit-site infection incidence of 0.06 episodes per patient-year.The main bacteria were Staphylococcus aureus(30.2%)and Pseudomonas aeruginosa(16.3%).Of the 39 infected patients,8(20.5%)had peritonitis and 3(7.7%)had been infected more than once.The exit-site Schaefer score of the 208 patients was 3.14±2.75.Of the 208 patients,204(98.1%)had received training of exit-site care from nurses,166(79.8%)could wash their hands and wear masks as required,196(94.2%)covered dressings on the exit site,and 184(88.5%)fixed catheters,but the application of antibiotic ointment did not follow the latest guidelines.The logistic regression analysis revealed that the history of redness and swelling at the exit site[odds ratio(OR)=7.926,95%confidence interval(CI)(2.367,26.535),P=0.001]and the history of traction-associated bleeding[OR=5.750,95%CI(1.878,17.610),P=0.002]were risk factors of exit-site infection.Conclusions Exit-site infection is common in peritoneal dialysis patients.Most patients can perform the exit-site care as required,but the care content is yet to be updated.Nursing staff should improve the training content according to the latest guidelines,strengthen the exit-site assessment,follow-up,and retraining,treat the redness and swelling at the exit site timely,and tell the patients to pay attention to catheter fixation and avoiding excessive traction,to prevent the exit-site infection and the further development of peritonitis.