维持性血液透析患者静脉导管相关血流感染的影响因素分析

Analysis on the influencing factors of venous catheter-related bloodstream infection in maintenance hemodialysis patients

目的探讨维持性血液透析患者静脉导管相关血流感染的影响因素。方法选择2019年12月至2020年12月在浙江省中西医结合医院行维持性血液透析患者532例的临床资料进行回顾性分析。记录患者的一般资料及临床资料,单因素及多因素分析维持性血液透析患者静脉导管相关血流感染的影响因素。结果(1)单因素分析结果显示,穿刺次数>2次、颈内静脉置管、留置时间≥30 d、有合并症、血清白蛋白<35 g/L、尿素氮≥21.4 mmol/L、血肌酐≥451μmol/L、白细胞计数≥10×109/L的患者感染发生率更高(P<0.001,P<0.05);感染组患者的平均年龄显著高于未感染组(P<0.001)。(2)多因素分析结果显示,患者年龄>60岁、穿刺次数>2次、留置时间≥30 d、有合并症是维持性血液透析患者静脉导管相关血流感染的独立危险因素(P<0.001),而血清白蛋白≥30 g/L是保护因素(P<0.001)。结论维持性血液透析患者静脉导管相关血流感染高危因素包括年龄>60岁、穿刺次数>2次、留置时间≥30 d、有合并症等,而患者血清白蛋白≥30 g/L是保护因素。临床上对于存在高危因素的患者应提高警惕,预防静脉导管相关血流感染的发生;同时,应提高穿刺技术,减少穿刺次数。

Objective To investigate the influencing factors of venous catheter-related bloodstream infection in maintenance hemodialysis patients.Methods The clinical data of 532 patients who underwent maintenance hemodialysis in Zhejiang Provincial Hospital of Integrated Traditional Chinese and Western Medicine from December 2019 to December 2020 were retrospectively analyzed.The general data and clinical data of the patients were recorded.The influencing factors of venous catheter-related bloodstream infection in maintenance hemodialysis patients were analyzed by univariate and multivariate analysis.Results(1)Univariate analysis showed that the incidence of infection was higher in patients with puncture times>2 times,internal jugular vein catheterization,indwelling time≥30 days,complications,serum albumin<35 g/L,urea nitrogen≥21.4 mmol/L,serum creatinine≥451μmol/L,and white blood cells counl≥10×109/L(P<0.001,P<0.05).The average age of patients in the infected group was significantly higher than that in the uninfected group(P<0.001).(2)Multivariate analysis results showed that age>60 years old,puncture times>2 times,indwelling time≥30 d,and comorbidities were independent risk factors for venous catheter-related bloodstream infection in maintenance hemodialysis patients(P<0.001),while serum albumin≥30 g/L was a protective factor(P<0.001).Conclusion The high-risk factors for venous catheter-related bloodstream infections in maintenance hemodialysis patients include age>60 years old,puncture times>2 times,indwelling time≥30 d,comorbidities,etc.While serum albumin≥30 g/L is a protective factor.Clinically,patients with high-risk factors should be vigilant to prevent the occurrence of venous catheter-related bloodstream infections.At the same time,the puncture technique should be improved to reduce the number of punctures.