维持性血液透析患者并发院内感染的危险因素及对策分析

Risk Factors and Countermeasure Analysis of Nosocomial Infection in Patients with Hemodialysis

目的探讨维持性血液透析(MHD)患者并发院内感染的特点及其相关危险因素并提出预防对策。方法回顾性收集745例MHD患者的临床资料,依据患者是否并发院内感染分为感染组(75例)和未感染组(670例);分析MHD患者感染发生率及其部位,采用χ2检验和多因素Logistic回归分别筛选MHD并发院内感染的危险因素。结果恩泽医院血液净化中心MHD患者院内感染率为10.07%(75/745),感染部位以呼吸道感染、泌尿道感染、胃肠道感染及导管相关感染为主;多因素Logistic回归结果显示,高龄(OR=2.912)、合并糖尿病肾病(OR=4.402)、透析时间长(OR=2.438)、血清白蛋白低(OR=3.695)、使用广谱抗生素(OR=3.504)、自护能力差(OR=3.254)为MHD并发院内感染的危险因素。结论 MHD患者并发院内感染发生率较高,应结合高危因素,早期采取有效预防措施,降低MHD患者院内感染发生率。

Objective To explore the characteristics and risk factors of nosocomial infection in patients with maintenance hemodialysis(MHD)and put forward prevention countermeasures.Methods We collected clinical data of 745 MHD patients and divided them into two groups:the infection group(75 cases with nosocomial infection)and the non-infection group(670 cases without nosocomial infection).The incidence rate and infection sites of nosocomial infection in MHD patients were described;we also usedχ2 test and multi-variable logistic regression to explore risk factors of nosocomial infection in MHD patients.Results The incidence rate of nosocomial infection in MHD patients in Blood Purification of Enze Hospital was 10.07%(75/745).The most common infection sites were respiratory infection,urinary tract infection,gastrointestinal tract infection and catheter related infection.Multivariable logistic regression analysis showed that older age(OR=2.912),diabetic nephropathy(OR=4.402),long duration of dialysis(OR=2.438),low level of serum albumin(OR=3.695),use of broad-spectrum antibiotics(OR=3.504)and bad self-care ability(OR=3.254)were risk factors of nosocomial infection.Conclusion MHD patients had a high incidence rate of nosocomial infection.The above risk factors should be considered.In combination with high-risk factors,effective preventive countermeasures should be taken early to reduce the incidence of nosocomial infection in patients with MHD.