老年2型糖尿病肾病血液透析期间肺部感染的危险因素分析

Risk factors of pulmonary infection during hemodialysis in elderly patients with type 2 diabetic nephropathy

目的观察老年2型糖尿病肾病患者血液透析期间肺部感染的危险因素。方法选取81例年龄>60岁的规律维持性血液透析2型糖尿病肾病患者进行观察,并对患者进行随访,观察患者肺部感染情况并分析影响因素。结果随访时间6~24月,共11例患者发生肺部感染,发生率为13.6%,其共感染22种病原菌,革兰阴性菌感染最高(68.2%)。肺部感染组患者年龄>80岁、糖尿病病程>10年、高血压、白蛋白≤35 g/L、总蛋白≤60 g/L、容量负荷、服用促胃动力药物、糖化血红蛋白>7%比例均高于无肺部感染组(P<0.05)。Logistic回归分析结果显示,年龄、容量负荷、使用促胃动力药物、糖化血红蛋白、白蛋白是老年糖尿病肾病血液透析期间肺部感染的独立影响因素(P<0.05)。结论年龄>80岁、容量负荷、使用促胃动力药物、高糖化血红蛋白、低白蛋白是老年2型糖尿病肾病患者在血液透析期间发生肺部感染的危险因素。

Aim To observe the risk factors of pulmonary infection during hemodialysis in elderly patients with diabetic nephropathy.Methods A total of 81 patients>60 years old with type 2 diabetic nephropathy who underwent regular maintenance hemodialysis were selected.The patients were followed up to observe the status of lung infection and analyze the influencing factors.Results The follow-up time ranged from 6 months to 24 months.A total of 11 patients developed pulmonary infections,with an incidence rate of 13.6%.11 patients with pulmonary infection were infected with 22 types of bacteria,among which Gram-negative bacteria infection was the highest(68.2%).In the lung infection group,the proportion of patients with age>80 years,diabetes>10 years,hypertension,albumin≤35 h/L,total protein≤60 g/L,volume load,taking prokinetic drugs,glycosylated hemoglobin>7%,were higher than that of the group without lung infection(P<0.05).Logistic regression analysis showed that age,volume load,use of prokinetic drugs,and glycated hemoglobin,albumin were independent influencing factors of hemodialysis-related pulmonary infection in elderly diabetic nephropathy(P<0.05).Conclusion Elderly diabetic nephropathy patients with age>80 years old,volume load,gastric motility drugs,and high glycated hemoglobin,low albumin are risk factors for pulmonary infection during hemodialysis in elderly patients with type 2 diabetic nephropathy.