腹膜透析相关性腹膜炎易感因素分析
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摘要
目的探讨医院腹膜透析相关性腹膜炎的易感因素。方法回顾性分析2014年4月至2017年5月腹膜透析患者临床资料,将腹膜透析相关性腹膜炎患者作为观察组,并将同期临床资料尽可能相匹配的非腹膜炎的腹膜透析患者作为对照组。所有患者按照不同透析龄分为透析<1年、1~3年、>3年者;按培训护士工龄分为<5年、6~10年、≥11年。比较不同透析龄及培训护士工龄腹膜炎发生率。并将依据病原菌的不同,比较真菌性腹膜炎与细菌性腹膜炎易感因素及预后比较。结果共纳入180例透析患者临床资料,观察组和对照组各90例,其中真菌性腹膜炎10例,细菌性腹膜炎80例。发生157例次腹膜炎,培养阳性率76.43%(120/157)。透析1~3年腹膜炎发生率最高,>3年者最低;培训护士工龄≤5年的患者腹膜炎发生率最高,明显高于培训护士工龄≥11年者,差异均具有显著性(P<0.05)。观察组腹膜透析患者血红蛋白(HGB)、血清白蛋白(ALB)低于对照组(P<0.05)。真菌性腹膜炎HGB较细菌性腹膜炎低,近1个月抗生素使用率较细菌性腹膜炎较高,差异具有显著性(P<0.05)。病原菌:真菌性11例次(9.17%),细菌性109例次(90.83%)。真菌性腹膜炎的病原菌以光滑念珠菌为主(27.27%),细菌性腹膜炎病原菌以革兰阳性菌69例次(63.30%)为主,其中表皮葡萄球菌最多(53.62%)。细菌性腹膜炎治愈率较真菌性腹膜炎高,病死率较真菌性腹膜炎低,两者比较差异具有显著性(P<0.05)。结论腹膜透析相关性腹膜炎患病率与其透析时间以及ALB水平相关,致病菌以革兰阳性菌为主,且细菌性腹膜炎较真菌性腹膜炎预后较好。
Objective To investigate the risk factors of peritonitis associated with peritoneal dialysis. Methods Peritoneal dialysis patients from April 2014 to May 2017 were retrospectively analyzed,patients with peritoneal dialysis related peritonitis were enrolled into the observation group,and the patients with non-peritonitis at the same period were selected as the control group. Patients were divided into different dialysis age groups according to different dialysis age < 1 year,1 to 3 years,> 3 years; according to the length of training nurses divided into < 5 years,6 to 10 years,≥ 11 years. The different dialysis ages and the incidence of peritonitis in nurses were compared. The fungal peritonitis and bacterial peritonitis susceptibility factors and prognosis were compared. Results A total of 180 patients with dialysis were included in the study,90 cases in each group. There were 10 cases of fungal peritonitis,and 80 cases of bacterial peritonitis. The cultivate positive rate was 76. 43%( 120/157).The results showed highest incidence of peritonitis in dialysis 1 ~ 3 years patients,and lowest in > 3 years patients,the incidence of peritonitis in nurses who were less than 5 years old was significantly higher than that of nurses who were more than 11 years( P < 0. 05). The levels of hemoglobin( HGB) and serum albumin( ALB) in the peritoneal dialysis patients were lower than those in the control group( P < 0. 05). HGB of fungal peritonitis was lower than that of bacterial peritonitis,nearly 1 month antibiotic use rate was higher than bacterial peritonitis,the difference was significant( P < 0. 05). There were 11 cases of fungal cases( 9. 17%),and 109 cases of bacterial cases( 90. 83%). The priority of fungal peritonitis was smooth candida( 27. 27%) and 69 cases of gram-positive bacteria from bacterial peritonitis( 63. 30%),the largest epidermis staphylococcus( 53. 62%). Bacterial peritonitis cure rate was relatively higher than fungal peritonitis,mortality was lower than those of fungal peritonitis,with statistically significant difference( P < 0. 05). Conclusion The prevalence of peritonitis associated with peritoneal dialysis in hospital is related to dialysis time and ALB level. Bacterial peritonitis has a better prognosis than fungal peritonitis.
Objective To investigate the risk factors of peritonitis associated with peritoneal dialysis. Methods Peritoneal dialysis patients from April 2014 to May 2017 were retrospectively analyzed,patients with peritoneal dialysis related peritonitis were enrolled into the observation group,and the patients with non-peritonitis at the same period were selected as the control group. Patients were divided into different dialysis age groups according to different dialysis age < 1 year,1 to 3 years,> 3 years; according to the length of training nurses divided into < 5 years,6 to 10 years,≥ 11 years. The different dialysis ages and the incidence of peritonitis in nurses were compared. The fungal peritonitis and bacterial peritonitis susceptibility factors and prognosis were compared. Results A total of 180 patients with dialysis were included in the study,90 cases in each group. There were 10 cases of fungal peritonitis,and 80 cases of bacterial peritonitis. The cultivate positive rate was 76. 43%( 120/157).The results showed highest incidence of peritonitis in dialysis 1 ~ 3 years patients,and lowest in > 3 years patients,the incidence of peritonitis in nurses who were less than 5 years old was significantly higher than that of nurses who were more than 11 years( P < 0. 05). The levels of hemoglobin( HGB) and serum albumin( ALB) in the peritoneal dialysis patients were lower than those in the control group( P < 0. 05). HGB of fungal peritonitis was lower than that of bacterial peritonitis,nearly 1 month antibiotic use rate was higher than bacterial peritonitis,the difference was significant( P < 0. 05). There were 11 cases of fungal cases( 9. 17%),and 109 cases of bacterial cases( 90. 83%). The priority of fungal peritonitis was smooth candida( 27. 27%) and 69 cases of gram-positive bacteria from bacterial peritonitis( 63. 30%),the largest epidermis staphylococcus( 53. 62%). Bacterial peritonitis cure rate was relatively higher than fungal peritonitis,mortality was lower than those of fungal peritonitis,with statistically significant difference( P < 0. 05). Conclusion The prevalence of peritonitis associated with peritoneal dialysis in hospital is related to dialysis time and ALB level. Bacterial peritonitis has a better prognosis than fungal peritonitis.
引文
[1]汪宏,姚永兴,方靖,等.腹膜透析患者退出原因分析[J].安徽医学,2012,33(8):1001-1003.
[2]维持性腹膜透析专家协作组.维持性腹膜透析共识[J].中华肾脏病杂志,2006,8(22):513-516.
[3]陈香美.腹膜透析标准操作规程[M].北京:人民军医出版社,2011:81-91.
[4]赵丽娟,孙世仁,杨君,等.腹膜透析相关性腹膜炎的致病菌及其易感因素分析[J].中华肾病研究电子杂志,2016,5(3):118-122.
[5]许戎,胡宁,阿荣其其格,等.腹膜透析相关性腹膜炎单中心8年变化趋势回顾分析[J].中国血液净化,2013,12(1):37-41.
[6]杨林,钟文旗,贾中尉,等.持续非卧床腹膜透析患者腹膜炎及相关因素的临床研究[J].医学临床研究,2012,29(9):1690-1692.
[7]熊子波,杨虹,廖玉梅,等.腹膜透析相关性腹膜炎169例次临床分析及转归[J].临床肾脏病杂志,2012,12(2):63-66.
[8]郭德明.对腹膜透析患者感染腹膜炎的病原菌及耐药情况分析[J].齐齐哈尔医学院学报,2012,33(5):591-592.
[9]彭卫生,周巧玲,敖翔,等.腹膜透析相关性腹膜炎的细菌谱及耐药性分析[J].中南大学学报(医学版),2012,37(12):1205-1209.
[10]吴晶晶,刘佳,张莉,等.腹膜透析相关性腹膜炎致病菌及耐药性分析[J].中华医院感染学杂志,2011,21(16):3521-3523.
[11]张连云,刘向东,张燕,等.68例次持续性非卧床腹透腹膜炎临床分析[J].中国实用医药,2010,5(18):131-133.
[12]薄其凤,梅小斌,郭志勇,等.腹膜透析相关性多重感染性腹膜炎的临床分析[J].第二军医大学学报,2012,33(6):646-649.
[13]田娜,马小琴,尤云,等.腹膜透析相关性腹膜炎的细菌学及耐药性分析[J].宁夏医学杂志,2011,33(8):730-732.
[2]维持性腹膜透析专家协作组.维持性腹膜透析共识[J].中华肾脏病杂志,2006,8(22):513-516.
[3]陈香美.腹膜透析标准操作规程[M].北京:人民军医出版社,2011:81-91.
[4]赵丽娟,孙世仁,杨君,等.腹膜透析相关性腹膜炎的致病菌及其易感因素分析[J].中华肾病研究电子杂志,2016,5(3):118-122.
[5]许戎,胡宁,阿荣其其格,等.腹膜透析相关性腹膜炎单中心8年变化趋势回顾分析[J].中国血液净化,2013,12(1):37-41.
[6]杨林,钟文旗,贾中尉,等.持续非卧床腹膜透析患者腹膜炎及相关因素的临床研究[J].医学临床研究,2012,29(9):1690-1692.
[7]熊子波,杨虹,廖玉梅,等.腹膜透析相关性腹膜炎169例次临床分析及转归[J].临床肾脏病杂志,2012,12(2):63-66.
[8]郭德明.对腹膜透析患者感染腹膜炎的病原菌及耐药情况分析[J].齐齐哈尔医学院学报,2012,33(5):591-592.
[9]彭卫生,周巧玲,敖翔,等.腹膜透析相关性腹膜炎的细菌谱及耐药性分析[J].中南大学学报(医学版),2012,37(12):1205-1209.
[10]吴晶晶,刘佳,张莉,等.腹膜透析相关性腹膜炎致病菌及耐药性分析[J].中华医院感染学杂志,2011,21(16):3521-3523.
[11]张连云,刘向东,张燕,等.68例次持续性非卧床腹透腹膜炎临床分析[J].中国实用医药,2010,5(18):131-133.
[12]薄其凤,梅小斌,郭志勇,等.腹膜透析相关性多重感染性腹膜炎的临床分析[J].第二军医大学学报,2012,33(6):646-649.
[13]田娜,马小琴,尤云,等.腹膜透析相关性腹膜炎的细菌学及耐药性分析[J].宁夏医学杂志,2011,33(8):730-732.