本文關鍵詞：湖南省腹膜透析腹膜炎發(fā)病率城鄉(xiāng)對比以及影響因素探討　出處：《湖南師范大學》2015年碩士論文　論文類型：學位論文

  更多相關文章： 腹膜透析 腹膜炎 城鄉(xiāng)對比 個人衛(wèi)生 腹瀉 便秘 影響因素

【摘要】：研究背景:終末期腎病(end-stage renal disease,ESRD)是指各種慢性腎臟病(Chronic kidney disease,CKD)的終末階段,在臨床中,腎功能達到CKD5期即進入了終末期腎病[1]。大多數(shù)終末期腎臟病患者在血液透析(hemodialysis,HD)中心進行血透治療,而在家庭透析治療中,腹膜透析(peritoneal dialysis,PD)則占主導地位。至2012年,全球PD人數(shù)占總透析人數(shù)11%[2]。在2011年底,我國有2.7萬余例患者進行腹膜透析治療,而在2012年底,腹膜透析人數(shù)已達到3.8萬余例,占透析總人數(shù)的13%[3]。PD因其自身的一些特點和優(yōu)點,例如所需設備簡單,易于操作;對血容量影響較小,不增加心臟負荷;保護殘余腎功能[4],現(xiàn)在腹膜透析被越來越多的人們所接受。腹膜透析相關性腹膜炎是腹膜透析治療中最常見和嚴重的并發(fā)癥之一,是導致腹膜透析患者拔管,退出腹膜透析治療最主要的原因[5],同時腹膜炎的發(fā)生會使腹膜功能下降,影響患者生存率[6]。此外,腹膜炎的發(fā)生也會在一定程度上增加患者的經(jīng)濟負擔,并且會對患者的生活質量產(chǎn)生嚴重的影響。近年來,隨著透析管路和透析液不斷改進,透析技術日益成熟,腹膜透析相關性腹膜炎發(fā)病率明顯下降,但它仍是引起患者住院、不能堅持腹膜透析的主要原因[7]。目前我國處于社會主義初級階段,城鄉(xiāng)發(fā)展不平衡,城鄉(xiāng)腹膜透析患者在地理環(huán)境、家庭衛(wèi)生條件、個人教育、個人衛(wèi)生習慣、疾病的認知能力、實際無菌操作過程等方面存在區(qū)別,腹膜炎發(fā)病率可能存在著城鄉(xiāng)區(qū)別。本文通過調查湖南省三個腹透中心,城鄉(xiāng)PD患者腹膜炎發(fā)生率,明確兩者是否存在區(qū)別,并進一步探討腹膜炎發(fā)生的可能影響因素,期望通過針對相關影響因素進行腹膜炎的預防,達到減少腹膜炎的目的,提高腹膜透析患者生活質量,減少透析失敗的風險。目的:調查湖南省城鄉(xiāng)腹膜透析腹膜炎的發(fā)病率,明確兩者是否存在區(qū)別,并進一步探討腹膜炎發(fā)生的可能影響因素,以期為臨床篩選出腹膜炎發(fā)病的高危人群,并期望通過針對相關危險因素進行腹膜炎的預防,從而減少腹膜炎的發(fā)生。方法:選取2013年1月至2014年12月在湖南省人民醫(yī)院、湘雅三醫(yī)院、邵陽市中心醫(yī)院三個大型腹膜透析中心capd患者,作為研究對象,一共納入1374名患者。根據(jù)患者長期居住地情況,分為城市組與農(nóng)村組。計算各腹透中心及總的城鄉(xiāng)腹膜炎發(fā)生率,分析兩者是否存在區(qū)別。另根據(jù)患者是否發(fā)生腹膜炎,分為腹膜炎組與非腹膜炎組,采用隨機抽樣方法,各抽取200例患者進行問卷調查,分析腹膜炎發(fā)生的可能危險因素。若城鄉(xiāng)腹膜炎發(fā)生率有差異,隨機抽樣城市組與農(nóng)村組患者各200例進行問卷調查,分析造成城鄉(xiāng)腹膜炎差異的可能影響因素。記錄capd患者一般資料(性別、年齡、居住地、文化程度等),狀態(tài)(在透、轉血透、死亡、移植),腹膜炎次數(shù),操作情況,個人衛(wèi)生情況,腹瀉便秘等情況。用spss22.0軟件建立數(shù)據(jù)庫,計量資料使用均數(shù)±標準差,采用t檢驗,計數(shù)資料使用頻數(shù)記錄,采用χ2檢驗,logistic多因素回歸分析影響因素。結果:1.城鄉(xiāng)兩組患者在性別、年齡上比較,差異無統(tǒng)計學意義(p0.05),城市腹膜炎發(fā)生率為0.19次/患者年(即1/62個患者月),農(nóng)村腹膜炎發(fā)生率為0.28次/患者年(即1/42個患者月),差異具有統(tǒng)計學意義(p0.05),農(nóng)村腹膜炎發(fā)病率高于城市。2.腹膜炎與一般資料分析:腹膜炎組與非腹膜炎組在長期居住地上比較,差異具有統(tǒng)計學意義(p0.05),長期居住地為農(nóng)村的患者發(fā)生腹膜炎風險高于城市患者,而在性別、年齡、體重指數(shù)、文化程度上比較,差異無統(tǒng)計學意義(p0.05)。3.腹膜炎與合并糖尿病分析:腹膜炎組與非腹膜炎組在是否合并糖尿病上比較,差異具有統(tǒng)計學意義(p0.05),合并糖尿病的患者腹膜炎發(fā)生率較未合并糖尿病患者高。4.腹膜炎與操作情況分析:腹膜炎組與非腹膜炎組在是否有固定換液房間、換液前洗手、戴口罩、碘伏帽使用、紫外線燈使用上比較,差異具有統(tǒng)計學意義(p0.05),沒有固定換液房間、換液前不洗手、不戴口罩、碘伏帽重復使用,操作臺沒有紫外線燈消毒的患者腹膜炎發(fā)生率高于有固定換液房間、換液前洗手、戴口罩、碘伏帽一次性使用、有紫外線燈消毒的患者。5.腹膜炎與個人衛(wèi)生習慣分析:腹膜炎組與非腹膜炎組在洗手頻率、刷牙頻率、夏天洗澡頻率上比較,差異具有統(tǒng)計學意義(p0.05),洗手頻率、刷牙頻率、夏天洗澡頻率低的患者腹膜炎發(fā)生率高于洗手頻率、刷牙頻率、夏天洗澡頻率高的患者。而在換牙刷頻率、曬洗被褥頻率、剪指甲頻率、灰指甲或手足癬上比較,差異無統(tǒng)計學意義(p0.05)。6.腹膜炎與腸道情況分析:兩組在腹瀉、便秘上比較,差異具有統(tǒng)計學意義(p0.05),有腹瀉或便秘情況的患者腹膜炎發(fā)生率高于沒有腹瀉便秘情況的患者。7.Logistic回歸方程分析:患者長期居住地、洗手次數(shù)、刷牙次數(shù)、腹瀉及便秘對回歸方程有統(tǒng)計學意義(p0.05),居住地為農(nóng)村的患者發(fā)生腹膜炎的風險是城市的5.876倍,平時洗手3到5次的患者發(fā)生腹膜炎的風險是洗手次數(shù)達10次以患者的5.961倍,每天刷牙小于等于1次的患者發(fā)生腹膜炎的風險是刷牙大于等于2次患者的3.947倍,存在腹瀉的患者發(fā)生腹膜炎的風險是沒有腹瀉患者的5.744倍,存在便秘的患者發(fā)生腹膜炎的風險是沒有便秘患者的2.021倍。8.造成城鄉(xiāng)腹膜炎差異的可能因素分析:城鄉(xiāng)兩組在文化程度、是否合并糖尿病、洗手次數(shù)、刷牙次數(shù)上比較,差異具有統(tǒng)計學意義(p0.05)。城市患者文化程度高于農(nóng)村患者,合并糖尿病多于農(nóng)村患者,洗手及刷牙次數(shù)多于農(nóng)村患者。而在一般資料及腹瀉便秘上比較,差異無統(tǒng)計學意義(p0.05)。結論:1.湖南省腹膜透析腹膜炎發(fā)病率存在城鄉(xiāng)區(qū)別,農(nóng)村腹膜炎發(fā)病率高于城市,農(nóng)村腹膜炎發(fā)病率為0.28次/患者年(即1/42個患者月),城市腹膜炎發(fā)病率為0.19次/患者年(即1/62個患者月),農(nóng)村患者發(fā)生腹膜炎風險是城市患者的5.876倍;2.合并糖尿病、腹透操作不規(guī)范、衛(wèi)生習慣差、腹瀉及便秘是腹膜炎發(fā)生的危險因素;3.城鄉(xiāng)腹膜炎差異可能與城鄉(xiāng)患者文化程度、合并糖尿病、洗手次數(shù)、刷牙次數(shù)不同有關。
[Abstract]:Background: end-stage renal disease (ESRD) is the end stage of Chronic kidney disease (CKD). In clinical practice, the renal function reaches the CKD5 stage, and then enters the end-stage renal disease [1]. Most end-stage renal disease patients are treated by hemodialysis in the hemodialysis (HD) center, while peritoneal dialysis (PD) is dominant in family dialysis. By 2012, the total number of PD in the world was 11%[2]. At the end of 2011, more than 27 thousand patients were treated by peritoneal dialysis. At the end of 2012, the number of peritoneal dialysis patients has reached over 38 thousand, accounting for 13%[3] of the total number of dialysis patients. Because of its own characteristics and advantages, such as simple equipment and easy operation, PD has little influence on blood volume, does not increase cardiac load, and protects residual renal function [4]. Now peritoneal dialysis has been accepted by more and more people. Peritoneal dialysis related peritonitis is one of the most common and serious complications of peritoneal dialysis. It is the most important reason for peritoneal dialysis patients to extubate and withdraw from peritoneal dialysis. Meanwhile, peritonitis causes peritoneal function decline and affects the survival rate of [6]. [5] In addition, the occurrence of peritonitis can also increase the financial burden of patients to a certain extent, and will have a serious impact on the quality of life of the patients. In recent years, with the continuous improvement of dialysis pipeline and dialysate, dialysis technology is becoming more and more mature, the incidence of peritoneal dialysis related peritonitis is significantly decreased, but it is still the main cause of hospitalization and can not adhere to peritoneal dialysis, [7]. At present our country is in the primary stage of socialism, the imbalance between urban and rural areas, urban and rural areas in peritoneal dialysis patients are different in geographical environment, family education, personal hygiene, personal hygiene, disease cognition, actual aseptic operation process, peritonitis rate may exist between urban and rural areas. In this paper, through the investigation of three dialysis centers in Hunan Province, the incidence rate of urban and rural PD patients with peritonitis, clear whether the two are different, and further explore the factors that may affect the occurrence of peritonitis, through the prevention of peritonitis according to related factors, to reduce the purpose of peritoneal inflammation, improve the quality of life of patients of peritoneal dialysis, reduce the risk of dialysis failure. Objective: To investigate the incidence of urban and rural areas of Hunan Province, the rate of peritoneal dialysis peritonitis, clear whether the two are different, and further explore the factors that may affect the occurrence of peritonitis, in order to identify high-risk patients for clinical peritonitis, and the prevention for the related risk factors for peritonitis, so as to reduce the incidence of peritonitis. Methods: from January 2013 to December 2014 in Hunan People's Hospital, Xiangya Hospital, Shaoyang Central Hospital, three large dialysis centers in CAPD patients as the research object, a total of 1374 patients. According to the situation of the long-term residence of the patient, it is divided into city group and rural group. Calculation of the dialysis center and the total urban and rural areas the incidence of peritonitis, analysis of whether the two are different. According to whether patients had peritonitis, they were divided into peritonitis group and non peritonitis group. 200 cases were selected by random sampling method, and the risk factors of peritonitis were analyzed by questionnaire. If there is a difference in incidence of peritonitis between urban and rural areas, a random questionnaire survey of 200 cases in urban and rural groups will be conducted to analyze possible factors that influence the difference between urban and rural peritonitis. The general information (gender, age, residence, education level, etc.), status (penetration, blood transfusion, death, transplant), number of peritonitis, operation condition, personal hygiene, diarrhea and constipation of CAPD patients were recorded. The database was set up by spss22.0 software. The data were measured by mean + standard deviation. T test was used. The frequency of counting data was recorded. Chi square test and multivariate logistic regression analysis were used to analyze the influencing factors. Results: 1. in urban and rural areas in two groups in gender, age, no significant difference (P0.05) city, the incidence of peritonitis was 0.19 times / patient year (1/62 patient months), the incidence of peritonitis was 0.28 times / patient year (1/42 patient months), the difference was statistically significant (P0.05), rural peritonitis incidence was higher than that of city. 2. data analysis: general peritonitis and peritonitis group and non peritonitis group in the long-term residence, the difference was statistically significant (P0.05), long-term residence for rural patients with peritonitis risk is higher than the city were compared in gender, age, body mass index, the degree, the difference was not statistically significant (P0.05). 3., peritonitis and diabetes mellitus: there was a statistically significant difference between the peritonitis group and non peritonitis group in the presence of diabetes mellitus (P0.05). The incidence of peritonitis in diabetic patients was higher than that in patients without diabetes mellitus. Operation situation analysis: 4. peritonitis and peritonitis group and non peritonitis group in whether there is a fixed liquid changing room, for washing hands, wearing masks, iodophor liquid, use ultraviolet lamp cap using comparison, the difference was statistically significant (P0.05), there is no fixed liquid changing room, change the liquid before washing, wearing masks, iodophor cap of repeated use, operation not ultraviolet light disinfection of the peritonitis rate is higher than the fixed liquid changing room, for washing hands, wearing masks, hats before liquid iodophor disposable, UV disinfection of patients. Analysis of 5. peritonitis and personal hygiene: comparison of peritonitis group and non peritonitis group in the hands of frequency, frequency of tooth brushing, summer bathing frequency, the difference was statistically significant (P0.05), washing frequency, frequency of tooth brushing, summer bathing frequency in patients with low incidence of peritonitis is higher than the frequency, frequency of tooth brushing, washing bath in patients with high frequency in summer. The frequency of the toothbrush, the frequency of the bedding and the bedding, the frequency of the nail clipper, the manicure, or the tinea pedis
【學位授予單位】：湖南師范大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R692.5

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本文編號：1345205