老年急诊血液透析患者中心静脉导管相关感染现状及危险因素分析

Current status and risk factors of central venous catheter-related infection in elderly patients with emergency hemodialysis

目的调查老年急诊血液透析患者发生中心静脉导管相关感染的情况,明确其危险因素,为其诊治提供依据。方法选取2018年1月—2022年12月于新疆医科大学第五附属医院行急诊血液透析的149例老年患者作为研究对象,根据患者是否发生中心静脉导管相关感染(CVC-RI)分为CVC-RI组(n=38)和无CVC-RI组(n=111)。收集2组患者的临床和实验室检查资料,采用多因素二元Logistic回归分析方法,明确CVC-RI发生的独立危险因素。结果38例患者发生CVC-RI,其中血流感染占比60.53%,穿刺口局部感染占比39.47%,培养以Gram阳性菌为主。与无CVC-RI组相比,CVC-RI组合并糖尿病、股静脉插管和插管时间≥2周比例和C反应蛋白水平更高,血红蛋白水平更低(均P<0.05)。多因素二元Logistic回归分析显示,合并糖尿病(OR=3.31,P=0.02)、股静脉插管(OR=2.58,P=0.01)、导管留置时间≥2周(OR=4.76,P=0.03)和C反应蛋白水平升高(OR=1.23,P<0.001)是CVC-RI发生的独立危险因素。结论合并糖尿病、股静脉插管、留置时间过久和C反应蛋白水平升高的患者发生CVC-RI的风险较高,值得临床诊治高度关注。

Objective To investigate the occurrence of central venous catheter-related infection(CVC-RI)in elderly emergency hemodialysis patients,identify its risk factors,and provide basis for its diagnosis and treatment.Methods A total of 149 elderly patients undergoing emergency hemodialysis in Fifth Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2022 were selected and divided into the CVC-RI group(n=38)and non-CVC-RI group(n=111)according to the occurrence of CVC-RI.The clinical and laboratory data of the two groups were collected.Multivariate binary logistic regression analysis was used to identify the independent risk factors of CVC-RI.Results 38 patients developed CVC-RI,with blood flow infection accounting for 60.53%and local infection at the puncture site accounting for 39.47%.Gram-positive bacteria were predominant in culture.Compared with the non-CVC-RI group,the proportion of CVC-RI combined with diabetes,femoral venin catheterization,indwelling time≥2 weeks,and C-reactive protein were significantly higher in the CVC-RI group,but the hemoglobin level was significantly lower(all P<0.05).Multivariate binary logistic regression analysis shows that diabetes(OR=3.31,P=0.02),femoral venous catheterization(OR=2.58,P=0.01),catheter indwelling time≥2 weeks(OR=4.76,P=0.03),and elevated C-reactive protein(OR=1.23,P<0.001)were independent risk factors for CVC-RI.Conclusion Patients with diabetes,femoral vein catheterization,prolonged indwelling time and elevated C-reactive protein level have a higher risk of CVC-RI,which is worthy of high attention in clinical diagnosis and treatment.