维持性血液透析患者导管相关感染风险预测模型构建与应对策略

Construction of a risk prediction model for catheter-related infection and treatment strategies of the infection in maintenance hemodialysis patients

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者导管相关感染(catheterrelated bloodstream infection,CRBSI)的影响因素,并构建预测模型与制订对策。方法选取深圳市龙华区人民医院MHD患者204例为对照组,将其分为感染组(n=63)和无感染组(n=141)。Logistic回归分析患者临床资料并构建模型;据模型、临床经验与文献报道,重新构建干预体系。另选取MHD患者198例为观察组,评价新干预体系效果。结果糖尿病史(OR=2.237,95%CI:1.067~5.679,P=0.003)、置管时间(OR=3.647,95%CI:1.326~7.892,P=0.024)、导管护理频率(OR=6.679,95%CI:2.534~16.476,P=0.003)、无菌培训率(OR=2.889,95%CI:1.146~6.654,P=0.030)、血尿酸(OR=2.937,95%CI:1.627~8.883,P=0.014)是MHD患者发生CRBSI的独立影响因素。预测模型方程为Y=-20.673+1.116×血尿酸+1.012×无菌培训率+2.017×导管护理频率+1.912×置管时间+1.079×糖尿病史,采用Hosmer和Lemeshow拟合优度检验方程(χ^(2)=10.678,P=0.236),受试者操作特征曲线显示曲线下面积为0.813,敏感性为89.47%,特异性为63.93%。观察组CRBSI发生率、不良事件发生率均低于对照组(χ^(2)=3.606、32.780,均P<0.001)。结论预测模型具有良好的判别效度,基于循证的系统化护理干预体系具有良好的防控MHD患者发生CRBSI效果。

Objective To investigate the influencing factors for catheter-associated infection(CRBSI),to construct a prediction model,and to build up treatment strategies of the injection in patients with maintenance hemodialysis(MHD).Methods A total of 204 MHD patients in our hospital were selected as the control subjects.They were divided into infected group(n=63)and non-infected group(n=141).Logistic regression was used to analyze the patients’clinical data and to construct the model.A new intervention system was then established based on the model,clinical experience and literature reports.In addition,a total of 198 MHD patients were selected as the observation subjects to evaluate the effects of the new intervention system.Results Diabetes history(OR=2.237,95%CI:1.067~5.679,P=0.003),catheter placement time(OR=3.647,95%CI:1.326~7.892,P=0.024),frequency of catheter care(OR=6.679,95%CI:2.534~16.476,P=0.003),aseptic training rate(OR=2.889,95%CI:1.146~6.654,P=0.030)and blood uric acid(OR=2.937,95%CI:1.627~8.883,P=0.014)were the independent influencing factors for CRBSI in MHD patients.The model equation was Y=-20.673+1.116×blood uric acid+1.012×aseptic training rate+2.017×catheter care frequency+1.912×catheterization time+1.079×diabetes history.Hosmer and Lemeshow's goodness of fit test equation was used(χ^(2)=10.678,P=0.236).Receiver operating characteristic curve showed that the area under the curve was 0.813,the sensitivity was 89.47%,and the specificity was 63.93%.The incidence of CRBSI and adverse events were lower in the observation group than those in the control group(χ^(2)=3.606 and 32.780;P<0.001).Conclusion The prediction model has a better discrimination validity,and the evidence-based systematic nursing intervention system has a better effect on preventing and controlling CRBSI in MHD patients.