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
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摘要
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 used χ2 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.
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 used χ2 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.
引文
1古贤君,王洁.血液透析患者院内感染的危险因素及预防的研究进展[J].右江医学,2017,45(1):116-118.
2 Toida T,Sato Y,Nakagawa H,et al.Glycaemic control is a predictor of infection-related hospitalization on haemodialysis patients:Miyazaki Dialysis Cohort study(MID study)[J].Nephrology,2016,21(3):236-240.
3中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
4常美,戴欢欢,徐骏,等.血液透析患者医院感染发生危险因素分析及健康教育干预[J].齐鲁护理杂志,2015,21(5):40-42.
5李松,孙希彩,潘晓静.维持性血液透析患者医院感染危险因素分析[J].中华医院感染学杂志,2015,25(2):385-386.
6杨娟.血液透析院内感染的风险因素与护理干预分析[J].泰山医学院学报,2015,36(6):686-687.
7 Ergunay K,Karagul A,Abudalal A,et al.Prospective investigation of the impact of West Nile Virus infections in renal diseases[J].Journal of Medical Virology,2015,87(10):1625-1632.
8王天生,王盛琴,王东红,等.终末期肾病维持血液透析患者应用左卡尼汀治疗对T淋巴细胞亚群和可溶性白细胞介素2受体的影响[J].中国慢性病预防与控制,2016,24(2):144-146.
9 See I,Shugart A,Lamb C,et a1.Infection control and bloodstream infection prevention:the perspective of patients receiving hemodialysis[J].Nephrol Nurs J,2014,41(1):37-9.
10罗玲,雷延兰,包越琴,等.重庆市维持性血液透析患者生活质量和自我护理能力的调查[J].解放军护理杂志,2016,33(10):37-39.
11陈艳华.血液透析置管感染危险因素分析及护理对策[J].护理实践与研究,2016,13(13):24-26.
12孙莉红,郑海燕.血液透析病人导管相关性血流感染影响因素分析及其护理对策[J].全科护理,2018,16(2):187-189.
2 Toida T,Sato Y,Nakagawa H,et al.Glycaemic control is a predictor of infection-related hospitalization on haemodialysis patients:Miyazaki Dialysis Cohort study(MID study)[J].Nephrology,2016,21(3):236-240.
3中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
4常美,戴欢欢,徐骏,等.血液透析患者医院感染发生危险因素分析及健康教育干预[J].齐鲁护理杂志,2015,21(5):40-42.
5李松,孙希彩,潘晓静.维持性血液透析患者医院感染危险因素分析[J].中华医院感染学杂志,2015,25(2):385-386.
6杨娟.血液透析院内感染的风险因素与护理干预分析[J].泰山医学院学报,2015,36(6):686-687.
7 Ergunay K,Karagul A,Abudalal A,et al.Prospective investigation of the impact of West Nile Virus infections in renal diseases[J].Journal of Medical Virology,2015,87(10):1625-1632.
8王天生,王盛琴,王东红,等.终末期肾病维持血液透析患者应用左卡尼汀治疗对T淋巴细胞亚群和可溶性白细胞介素2受体的影响[J].中国慢性病预防与控制,2016,24(2):144-146.
9 See I,Shugart A,Lamb C,et a1.Infection control and bloodstream infection prevention:the perspective of patients receiving hemodialysis[J].Nephrol Nurs J,2014,41(1):37-9.
10罗玲,雷延兰,包越琴,等.重庆市维持性血液透析患者生活质量和自我护理能力的调查[J].解放军护理杂志,2016,33(10):37-39.
11陈艳华.血液透析置管感染危险因素分析及护理对策[J].护理实践与研究,2016,13(13):24-26.
12孙莉红,郑海燕.血液透析病人导管相关性血流感染影响因素分析及其护理对策[J].全科护理,2018,16(2):187-189.