预防血液透析导管相关性感染的研究进展
|
摘要
血液透析是用于急、慢性肾衰竭患者的一种有效的替代疗法之一,那些需要紧急透析或短期透析还没有建立动静脉内瘘的患者,一般多通过留置中心静脉导管,作为透析血管的通路。值得一提的是,中心静脉导管属于紧急/短期血液透析血管通路。但是,广泛应用容易发生并发症情况,如:感染、血栓、血管受损等。导管相关性血流感染CRBSI发生率最高,直接关系到透析的效果,易于引发导管拔出情况,严重条件下还会威胁到患者的生存质量。李月婷等报道的采用临时留置的导管进行血液透析治疗的患者中,有11%-21%的患者可发生导管感染,目前,针对预防透析导管相关感染的研究也有不少文献报道,取得良好的效果,本文从透析导管相关性感染的概念;患者的年龄、留置导管时间、留置导管的位置,合并症等发生的危险因素;护理等三方面进行综述。为临床护理工作提供有力的依据。
Hemodialysis is one of effective alternative therapies for acute and chronic renal failure patients.Patients needing emergency dialysis or short-term dialysis without arteriovenous fistula usually apply central venous catheter indwelling as access of dialysis vessels. It is worth mentioning, central venous catheter is an emergency/shortterm hemodialysis vascular access. However, complicationsare prone to occur during wide application, including infection, thrombosis, vascular damage and so on. Catheter-related bloodstream infection(CRBSI) has the highest incidence, which is related to dialysis effect directly, and easy to cause catheter pull-out and threatens life quality of patients under severe conditions. Li Yueting et al. reported that 11%-21% of hemodialysis patients with temporary indwelling catheter can suffer from catheter infection. At present, many literature reports that prevention of catheterrelated infection in dialysis patients achieved good results. The paper reviews concept of catheter-related infection of dialysis; patient's age, indwelling catheter time, indwelling catheter position, complications risk factors and nursing, to provide strong basis for clinical nursing.
Hemodialysis is one of effective alternative therapies for acute and chronic renal failure patients.Patients needing emergency dialysis or short-term dialysis without arteriovenous fistula usually apply central venous catheter indwelling as access of dialysis vessels. It is worth mentioning, central venous catheter is an emergency/shortterm hemodialysis vascular access. However, complicationsare prone to occur during wide application, including infection, thrombosis, vascular damage and so on. Catheter-related bloodstream infection(CRBSI) has the highest incidence, which is related to dialysis effect directly, and easy to cause catheter pull-out and threatens life quality of patients under severe conditions. Li Yueting et al. reported that 11%-21% of hemodialysis patients with temporary indwelling catheter can suffer from catheter infection. At present, many literature reports that prevention of catheterrelated infection in dialysis patients achieved good results. The paper reviews concept of catheter-related infection of dialysis; patient's age, indwelling catheter time, indwelling catheter position, complications risk factors and nursing, to provide strong basis for clinical nursing.
引文
[1]徐芳丽,焦军东.血液透析导管相关性感染的诊断及治疗进展[J].中国中西医结合肾病杂志,2016(3):281-282.
[2]李月婷,车丽双,黄荣桂.血液透析导管相关性血流感染的病原学分析[J].中华医院感染学杂志,2015,25(12):2707-2708,2711.
[3]Lata C,Girard L,Parkins M,et al.Catheter-Related Bloodstream Infection in End-Stage Kidney Disease:A Canadian Narrative Review[J].Canadian Journal of Kidney Health and Disease,2016,(3):115.
[4]杨春琴,黄敏,翁明祥.血液透析患者导管相关性血流感染病原菌分布与危险因素分析[J].中华医院感染学杂志,2015(9):2028-2029.
[5]张赟,李娅,孟梅霞,等.血液透析患者静脉导管感染病原菌的分布及感染因素分析[J].海南医学,2016(12):1978-1980.
[6]陈彤.103例尿毒症血液透析患者医院感染危险因素分析[J].现代预防医学,2011,38(20):4110-4111.
[7]张清霞,邱晶,王丽莹.腹膜透析与血液透析在糖尿病肾病尿毒症高血压中的应用效果比较[J].护理实践与研究,2015,12(7):32-33.
[8]郭晓燕,冯晓楠.血液透析患者中心静脉临时导管感染危险因素分析[J].宁夏医学杂志,2018.40(3):280-282.
[9]潘杨,张雪芹,刘仙蓉.尿毒症血液透析患者留置导管所致感染的多因素分析及护理对策[J].山西医药杂志,2018,47(15):1861-1863.
[10]罗志立,田世川,杨培俊.留置中心静脉导管行血液透析并发感染的危险因素分析[J].吉林医学,2016,37(7):1832-1833.
[11]张丽萍,付阿丹,朱江,等.血液透析患者导管相关性血流感染风险评估研究[J].中华医院感染学杂志,2015,25(23):5423.
[12]蓝天座,于黔.维持性血液透析患者中心静脉置管感染的相关因素分析[J].慢性病学杂志,2015,16(3):265.
[13]王海燕.肾脏病学[M].第2版,北京:人民卫生出版社,1997.
[14]单亦升,黄秀芹,雷鸣,等.尿毒症持续血液透析患者医院感染的临床分析[J].中华医院感染学杂志,2014,24(8):1947-1949.
[15]王奇娟,王少亭,胡晓舟,等.透析患者临时性中心静脉导管相关性血流感染危险因素分析[J].系统医学2018.3(19):13.
[16]Menegueti MG,Betoni NC,Bellissimo-Rodrigues F,et al.Central venous catheter-related infections in patients receiving short-term hemodialysistherapy:inci dence,associatedfactors,andmicrobiological aspects[J].Rev SocBras Med Trop,2017,50(6):783-787.
[17]方帆,杜晓刚.尿毒症患者导管相关性血流感染的危险因素分析[J].中国血液净化,2017(6):423-426.
[18]徐小芳,康圆超,朱春黎,等.糖尿病合并肺部感染与治疗分析[J].西北药学杂志,2018,33(1):121-124.
[19]徐丽丽,李丹,候彩妍,等.PICC导管相关性感染危险因素分析及护理措施[J].中华医院感染学杂志,2011,21(19):4043-4045.
[20]钟海宁,李俊凤,张爱丽.循证护理在心脏直视术后中心静脉导管相关性感染中的应用观察[J].中华全科医学,2016,14(10):1772-1774.
[21]马春花.手卫生质量持续改进对ICU中心静脉导管相关血流感染发生率的影响[J].职业与健康,2015,31(14):1990-1992.
[22]江培兰,蔡照红,吴兰.血液透析导管相关性血流感染患者集束化护理干预的预防作用[J].中华医院感染学杂志,2015,25(8):1805-1807.
[23]周翠芹.血透透析患者中心静脉导管感染的护理新进展[J].上海护理2015,15(1):68-71.
[24]谭庆,廖小平.葡萄糖酸氯已定醇预防血液透析中心静脉导管相关感染的研究[J].中国消毒学杂志,2016,33(12):1160-1161.
[25]张帆,肖友文,王勤.两种消毒剂在预防血液透析导管相关性血流感染中的效果研究[J].中国医学装备,2017,14(7):52-53.
[26]王鑫,王媛媛,孙亚南,等.不同敷料在血液透析颈内静脉留置导管中的应用效果比较[J].安徽医药,2018,22(8):1542-1544.
[27]蔡天蕊,刘金凤,姜晓雪,等.水胶体敷贴在血液透析中的应用[J].黑龙江医药科学,2011,34(5):111.
[28]陈娟红,黄超兰,呼邦传.银离子抗菌敷料预防危重患者临时性血透导管感染的效果评价[J].中华现代护理杂志,2015,21(32):3956-3957.
[29]郭娟,张芸.康惠尔透明贴联合藻酸盐敷料在人工肝股静脉置管中的应用[J].护理实践与研究,2016,13(2):141-142.
[2]李月婷,车丽双,黄荣桂.血液透析导管相关性血流感染的病原学分析[J].中华医院感染学杂志,2015,25(12):2707-2708,2711.
[3]Lata C,Girard L,Parkins M,et al.Catheter-Related Bloodstream Infection in End-Stage Kidney Disease:A Canadian Narrative Review[J].Canadian Journal of Kidney Health and Disease,2016,(3):115.
[4]杨春琴,黄敏,翁明祥.血液透析患者导管相关性血流感染病原菌分布与危险因素分析[J].中华医院感染学杂志,2015(9):2028-2029.
[5]张赟,李娅,孟梅霞,等.血液透析患者静脉导管感染病原菌的分布及感染因素分析[J].海南医学,2016(12):1978-1980.
[6]陈彤.103例尿毒症血液透析患者医院感染危险因素分析[J].现代预防医学,2011,38(20):4110-4111.
[7]张清霞,邱晶,王丽莹.腹膜透析与血液透析在糖尿病肾病尿毒症高血压中的应用效果比较[J].护理实践与研究,2015,12(7):32-33.
[8]郭晓燕,冯晓楠.血液透析患者中心静脉临时导管感染危险因素分析[J].宁夏医学杂志,2018.40(3):280-282.
[9]潘杨,张雪芹,刘仙蓉.尿毒症血液透析患者留置导管所致感染的多因素分析及护理对策[J].山西医药杂志,2018,47(15):1861-1863.
[10]罗志立,田世川,杨培俊.留置中心静脉导管行血液透析并发感染的危险因素分析[J].吉林医学,2016,37(7):1832-1833.
[11]张丽萍,付阿丹,朱江,等.血液透析患者导管相关性血流感染风险评估研究[J].中华医院感染学杂志,2015,25(23):5423.
[12]蓝天座,于黔.维持性血液透析患者中心静脉置管感染的相关因素分析[J].慢性病学杂志,2015,16(3):265.
[13]王海燕.肾脏病学[M].第2版,北京:人民卫生出版社,1997.
[14]单亦升,黄秀芹,雷鸣,等.尿毒症持续血液透析患者医院感染的临床分析[J].中华医院感染学杂志,2014,24(8):1947-1949.
[15]王奇娟,王少亭,胡晓舟,等.透析患者临时性中心静脉导管相关性血流感染危险因素分析[J].系统医学2018.3(19):13.
[16]Menegueti MG,Betoni NC,Bellissimo-Rodrigues F,et al.Central venous catheter-related infections in patients receiving short-term hemodialysistherapy:inci dence,associatedfactors,andmicrobiological aspects[J].Rev SocBras Med Trop,2017,50(6):783-787.
[17]方帆,杜晓刚.尿毒症患者导管相关性血流感染的危险因素分析[J].中国血液净化,2017(6):423-426.
[18]徐小芳,康圆超,朱春黎,等.糖尿病合并肺部感染与治疗分析[J].西北药学杂志,2018,33(1):121-124.
[19]徐丽丽,李丹,候彩妍,等.PICC导管相关性感染危险因素分析及护理措施[J].中华医院感染学杂志,2011,21(19):4043-4045.
[20]钟海宁,李俊凤,张爱丽.循证护理在心脏直视术后中心静脉导管相关性感染中的应用观察[J].中华全科医学,2016,14(10):1772-1774.
[21]马春花.手卫生质量持续改进对ICU中心静脉导管相关血流感染发生率的影响[J].职业与健康,2015,31(14):1990-1992.
[22]江培兰,蔡照红,吴兰.血液透析导管相关性血流感染患者集束化护理干预的预防作用[J].中华医院感染学杂志,2015,25(8):1805-1807.
[23]周翠芹.血透透析患者中心静脉导管感染的护理新进展[J].上海护理2015,15(1):68-71.
[24]谭庆,廖小平.葡萄糖酸氯已定醇预防血液透析中心静脉导管相关感染的研究[J].中国消毒学杂志,2016,33(12):1160-1161.
[25]张帆,肖友文,王勤.两种消毒剂在预防血液透析导管相关性血流感染中的效果研究[J].中国医学装备,2017,14(7):52-53.
[26]王鑫,王媛媛,孙亚南,等.不同敷料在血液透析颈内静脉留置导管中的应用效果比较[J].安徽医药,2018,22(8):1542-1544.
[27]蔡天蕊,刘金凤,姜晓雪,等.水胶体敷贴在血液透析中的应用[J].黑龙江医药科学,2011,34(5):111.
[28]陈娟红,黄超兰,呼邦传.银离子抗菌敷料预防危重患者临时性血透导管感染的效果评价[J].中华现代护理杂志,2015,21(32):3956-3957.
[29]郭娟,张芸.康惠尔透明贴联合藻酸盐敷料在人工肝股静脉置管中的应用[J].护理实践与研究,2016,13(2):141-142.