血液透析患者的感染及相关因素分析

A survey of infection episode and related risk factors in maintenance hemodialysis patients

目的 了解感染及相关因素与血液透析(血透)患者生存质量的关系。方法 对1997.1. 1～2001.4.30间因感染住院的62例血透患者的临床资料进行回顾性分析,对感染部位、病原体、疗程、心胸比例及营养情况等进行比较统计。结果 62例血透患者共发生了72例次感染。感染部位主要为肺部(51.4％)和血管通路(16.7％)。病原学检查检出革兰氏阳性菌15例次,革兰氏阴性菌4例次,真菌8例次,混合感染10例次。患者平均Hb和Alb分别为72.5 g/L和32.8 g/L。抗感染平均疗程和住院天数分别为16 d和26 d。肺部和多部位感染患者中心胸比例>0.5者较多,肠道和肺部感染患者中糖尿病的比例较高。结论 血透患者感染菌种主要是革兰氏阳性菌,肺部感染的发生率较高。低血红蛋白水平及较差的营养状况可能加重了血透患者的免疫力低下状况。

Objective To elucidate the relationship of quality of life in hemodialysis(HD) patients to infection and associated factors. Methods Clinical data of 62 HD patients between January 1, 1997 and April 30, 2001 were enrolled in this retrospective study of hospitalized cases of infection. The infection site, pathogens, treatment duration, the presence of radiological evidence of cardiac enlargement and nutrition status were analyzed. Results During above period, 72 infection episodes occurred. The major infection sites were lung(51. 4% ) and vascular access (16. 7% ) . Pathogenic examination showed that 15 episodes were caused by gram-positive bacteria, 4 episodes by gram-negative bacteria, 8 episodes by fungi, and 10 episodes by mixed micro-organisms. The average levels of hemoglobin and albumin were 72. 5 g/L and 32. 8 g/L respectively. Patients were treated by antibiotics for around 16 days and were hospitalized for about 26 days. The number of patients with cardiac enlargement was higher in the group of pneumonia and the group of mixed sites infection. In the group of gastrointestinal infection and group of pneumonia, there were more patients with ESRD caused by diabetic mellitus. Conclusions The main infection cause in HD patients is gram-positive bacteria. The incidence of pneumonia is rather high. The deficiency of immune system may be deteriorated by the lower level of hemoglobin and poor nutrition status.