某院血液透析事件监测结果分析
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摘要
目的 了解某血液透析中心血液透析事件现状与影响因素。方法 对某血液透析中心2017年6月-2018年5月每月前两个工作日内进行血液透析的患者1 000人次,采用统一的调查表进行血透室事件的前瞻性调查。结果 发生血液透析事件55例,发生率为5.50%。住院81例,住院率为8.10%;死亡5例,死亡率为0.50%。非隧道式中心静脉置管患者血透事件的发生率、住院率和死亡率分别为30.77%(12/39)、43.59%(17/39)、5.13%(2/39)均高于隧道式中心静脉置管、人工血管和内瘘患者(P<0.05)。血液透析事件类型最多的是使用抗菌药物46例,使用率为4.60%,用药途径以静脉滴注为主;其他具体问题以肺炎为主。年龄与合并糖尿病是血液透析事件发生的影响因素(P<0.05)。结论 通过监测可了解血液透析事件的现状与危险因素,有利于制定针对性预防控制措施,降低血液透析事件的发生。
OBJECTIVE To investigate the current status and influencing factors of hemodialysis events in a hemodialysis center. METHODS A total of 1000 patients who underwent hemodialysis within the first two workdays of every month from Jun. 2017 to May 2018 in a hemodialysis center were enrolled in the study, and a prospective survey was conducted using a unified questionnaire. RESULTS 55 cases of hemodialysis events occurred, with the incidence rate of 5.50%. Among them, 81 patients were hospitalized, with an incidence rate of 8.10%. There were 5 deaths with a mortality rate of 0.50%. The incidence, hospitalization rate and mortality of hemodialysis events in patients with non-tunnel central venous catheterization were 30.77%(12/39), 43.59%(17/39) and 5.13%(2/39), respectively, all significantly higher than those in patients with tunnel central venous catheterization, artificial blood vessel and internal fistula(P<0.05). The use of antibiotics drugs was the predominant hemodialysis event, accounting for 4.6%(46 cases), and intravenous drip was the major route of administration. Other specific problems were mainly pneumonia. Age, dialysis time and diabetes mellitus were the influencing factors of hemodialysis events(P<0.05). CONCLUSION Through the surveillance, we can understand the current status of hemodialysis events and their risk factors, which is conducive to the development of targeted prevention and control measures to reduce the occurrence of hemodialysis events.
OBJECTIVE To investigate the current status and influencing factors of hemodialysis events in a hemodialysis center. METHODS A total of 1000 patients who underwent hemodialysis within the first two workdays of every month from Jun. 2017 to May 2018 in a hemodialysis center were enrolled in the study, and a prospective survey was conducted using a unified questionnaire. RESULTS 55 cases of hemodialysis events occurred, with the incidence rate of 5.50%. Among them, 81 patients were hospitalized, with an incidence rate of 8.10%. There were 5 deaths with a mortality rate of 0.50%. The incidence, hospitalization rate and mortality of hemodialysis events in patients with non-tunnel central venous catheterization were 30.77%(12/39), 43.59%(17/39) and 5.13%(2/39), respectively, all significantly higher than those in patients with tunnel central venous catheterization, artificial blood vessel and internal fistula(P<0.05). The use of antibiotics drugs was the predominant hemodialysis event, accounting for 4.6%(46 cases), and intravenous drip was the major route of administration. Other specific problems were mainly pneumonia. Age, dialysis time and diabetes mellitus were the influencing factors of hemodialysis events(P<0.05). CONCLUSION Through the surveillance, we can understand the current status of hemodialysis events and their risk factors, which is conducive to the development of targeted prevention and control measures to reduce the occurrence of hemodialysis events.
引文
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[15] Badawy DA,Mowafi HS,Al-Mouse HH.Surveillance of dialysis events:12-month experience at five outpatient adult hemodialysis centers in Kuwait[J].J Infect Public Health,2014,7(5):386-391.
[16] Thomson BK,Huang SH,Chan C,et al.Nocturnal home hemodialysis associates with improvement of electocardiographic features linked to sudden cardiac death[J].ASAIO J,2014,60(1):99-105.
[17] Allon M,Brouwer-Maier DJ,Abreo K,et al.Recommended clinical trial end points for dialysis catheters[J].Clin J Am Soc Nephrol,2018,13(3):495-500.
[18] Balkhy HH,El-Saed A,Al Hejaili F,et al.Decreasing but differential trends of adverse events among dialysis outpatient following re-enforcement of infection control measures;20-month surveillance study[J].BMC Proc,2011,5(Suppl 6):208.
[19] 张菊,杨俊华,刘玉苗,等.连续两年医院感染现患率调查与分析[J].华西医学,2014,29(2):286-288.
[20] Chand DH,Teo BW,Fatica RA,et al.Influence of vascular access type on outcome measures in patients on maintenance hemodialysis[J].Nephron Clin Pract,2008,108(2):c91-98.
[21] John S.Complication in diabetic nephropathy[J].Diabetes Metab Syndr,2016,10(4):247-249.
[22] Tazza L,Di Napoli A,Bossola M,et al.Ageing of patients on chronic dialysis:effects on mortality--a 12-year study[J].Nephrol Dial Transplant,2009,24(3):940-947.
[23] Patel PR,Kallen AJ,Arduino MJ.Epidemiology,surveill-ance,and prevention of bloodstream infections in hemodialysis patients[J],Am J Kidney Dis,2010,56(3):566-577.
[24] 王文静,张燕,唐伟华.血液透析患者导管相关性血流感染的影响因素分析[J].中华医院感染学杂志,2014,24(16):4004-4005,4008.
[25] 胡玉纹,陈学波,张亮,等.血液透析患者医院感染危险因素分析及预防对策[J].中华医院感染学杂志,2014,24(1):128-129,135.
[2] 周莉,付平.社区开展血液透析可能遇到的问题及可能解决方案[J].中国血液净化,2017,16(3):145-147.
[3] Schweiger A,Trevino S,Marschall J.Nosocomial infections in dialysis access[J].Contrib Nephrol,2015,184:205-221.
[4] Norris KC,Williams SF,Rhee CM,et al.Hemodialysis disparities in Americans;the deeply integrated concept of race in the social fabric of our society[J].Semin Dial,2017,30(3):213-223.
[5] Samani S,Saffari M,Charkhchian M,et al.Incidence and risk factors of bloodstream catheter-related infections in hemodialysis patients[J].Comparative Clinical Pathology,2015,24(2):275-279.
[6] Klevens RM,Edwards JR,Andrus ML,et al.Special re-port:dialysis surveillance report:national healthcare safety network(NHSN)-date summary for 2006[J].Semin Dial,2008,21(1):24-28.
[7] Gupta N,Cannon M,Srinivasan A.National agenda for prevention of healthcare-associated infections in dialysis centers[J].Semin Disl,2013,26(4):376-383.
[8] Trepanier P,Quach C,Gonzales M,et al.Suvey of infection control practices in henodialysis units:preventing vascular access-associated bloodstream infections[J].Infect Control Hosp Epidemiol,2014,35(7):833-838.
[9] Favero MS.Role of the CDC in hemodialysis;an historical perspective[J].Semin Dial,2000,13(2):64-67.
[10] 李六亿,吴安华.胡必杰.如何提高医院感染预防与控制能力[M].北京:北京大学医学出版社,2015:190-215.
[11] 张慧,宗志勇.门诊血液透析患者血液透析事件监测进展[J].中国感染控制杂志,2015,14(8):565-570.
[12] Tokars JI,Miller ER,Stein G.New national surveillance system for hemodialysis-associated infections:initial results[J].Am J Infect Control,2002,30(5):288-295.
[13] 陈香美.血液净化标准操作规程[M].北京:人民军医出版社,2010,3.
[14] 胡春华,李婷婷,王玉莲,等.血液净化中心阴沟肠杆菌血流感染疑似暴发的调查与控制[J].中国感染控制杂志,2019(4):358-362.
[15] Badawy DA,Mowafi HS,Al-Mouse HH.Surveillance of dialysis events:12-month experience at five outpatient adult hemodialysis centers in Kuwait[J].J Infect Public Health,2014,7(5):386-391.
[16] Thomson BK,Huang SH,Chan C,et al.Nocturnal home hemodialysis associates with improvement of electocardiographic features linked to sudden cardiac death[J].ASAIO J,2014,60(1):99-105.
[17] Allon M,Brouwer-Maier DJ,Abreo K,et al.Recommended clinical trial end points for dialysis catheters[J].Clin J Am Soc Nephrol,2018,13(3):495-500.
[18] Balkhy HH,El-Saed A,Al Hejaili F,et al.Decreasing but differential trends of adverse events among dialysis outpatient following re-enforcement of infection control measures;20-month surveillance study[J].BMC Proc,2011,5(Suppl 6):208.
[19] 张菊,杨俊华,刘玉苗,等.连续两年医院感染现患率调查与分析[J].华西医学,2014,29(2):286-288.
[20] Chand DH,Teo BW,Fatica RA,et al.Influence of vascular access type on outcome measures in patients on maintenance hemodialysis[J].Nephron Clin Pract,2008,108(2):c91-98.
[21] John S.Complication in diabetic nephropathy[J].Diabetes Metab Syndr,2016,10(4):247-249.
[22] Tazza L,Di Napoli A,Bossola M,et al.Ageing of patients on chronic dialysis:effects on mortality--a 12-year study[J].Nephrol Dial Transplant,2009,24(3):940-947.
[23] Patel PR,Kallen AJ,Arduino MJ.Epidemiology,surveill-ance,and prevention of bloodstream infections in hemodialysis patients[J],Am J Kidney Dis,2010,56(3):566-577.
[24] 王文静,张燕,唐伟华.血液透析患者导管相关性血流感染的影响因素分析[J].中华医院感染学杂志,2014,24(16):4004-4005,4008.
[25] 胡玉纹,陈学波,张亮,等.血液透析患者医院感染危险因素分析及预防对策[J].中华医院感染学杂志,2014,24(1):128-129,135.