【摘要】：目的:分析血液透析半永久透析導管相關性感染的危險因素。方法:選取2011.12-2014.12威海404醫(yī)院腎內科就診的留置半永久透析導管的患者29例。28例采用右頸內靜脈置管術,1例采用左頸內靜脈置管術(右頸內靜脈畸形、狹窄)。以上患者采用seldinger技術進行穿刺和撕脫鞘導管置入法。根據導管相關性感染的診斷標準:①出口部感染:導管出口處2cm以內范圍內的皮膚發(fā)紅、腫脹、疼痛、有膿性分泌物或者分泌物培養(yǎng)陽性,有或者無血流感染。②隧道感染:感染沿著導管口及導管置入方向繼續(xù)感染超過2cm�？捎芯植克淼啦课坏奶弁础⒛[脹、發(fā)熱,沿導管口擠壓后可能有膿性分泌物流出,伴或者不伴有血流感染,分泌物培養(yǎng)陽性。③導管相關性菌血癥(CRB)的表現(xiàn):透析過程中出現(xiàn)寒戰(zhàn)、發(fā)熱,部分患者免疫力低下,僅表現(xiàn)為低熱、低血壓、低血糖等。確診標準:導管內血培養(yǎng)呈陽性,導管內血培養(yǎng)的菌落數大于100cfu/ml,導管內及外周血培養(yǎng)為同一細菌,導管血培養(yǎng)細菌數為外周血細菌數的5倍。將以上29人分為導管相關性感染組(感染組)及無導管相關性感染組(非感染組)。分析年齡、性別、生活環(huán)境、血紅蛋白、血白蛋白、血肌酐、原發(fā)病、導管留置時間等與導管相關性感染的相關性。統(tǒng)計學處理:導管相關性感染的發(fā)生率用導管感染的例次與導管留置日的比來表示,即例次/1000導管日。用SPSS11.0軟件進行統(tǒng)計學分析。計數資料采用卡方檢驗,P0.05為具有統(tǒng)計學意義。結果:1.生活環(huán)境差、血紅蛋白90g/L,是半永久透析導管相關性感染的危險因素,P0.05.2.性別、年齡、血白蛋白、血肌酐、原發(fā)疾病、導管留置時間等單因素與半永久透析導管相關感染的發(fā)生率無明顯相關,P0.05.結論:生活環(huán)境差、血紅蛋白90g/L,可能是導管相關性感染的危險因素。
[Abstract]:Objective: to analyze the risk factors of catheter-associated infection in hemodialysis. Methods: Twenty-nine patients with semi-permanent dialysis catheter were selected from Department of Nephrology, Weihai 404 Hospital from January 12 to December 2014.28 cases were treated with right internal jugular vein catheterization, 1 case with left internal jugular vein catheterization (malformation of right internal jugular vein, stenosis). Seldinger technique was used for puncture and avulsion catheter placement. According to the diagnostic criteria of catheter-related infection: 1Exporting infection: the skin within 2cm at the outlet of the catheter is redness, swelling, pain, and positive for purulent secretion or secretion culture. With or without bloodstream infection. 2 Tunnel infection: infection continues to infect more than 2 cm along the catheter orifice and catheter placement. There may be pain, swelling, fever at the local tunnel site, and there may be purulent discharge of secretions, with or without blood flow infection, after pressing along the duct orifice. Secretion culture was positive. 3 the manifestation of (CRB): shivering, fever, low immunity in some patients, only low fever, hypotension, hypoglycemia and so on. The positive rate of blood culture was positive in ductal blood culture. The colony number of blood culture in catheter was more than 100 cfur / ml. The bacteria cultured in catheter and peripheral blood were the same bacteria, and the number of bacteria cultured in catheter blood was 5 times of that in peripheral blood. The above 29 patients were divided into two groups: catheter associated infection group (infection group) and non-catheter-associated infection group (non-infection group). To analyze the correlation between age, sex, living environment, hemoglobin, serum albumin, serum creatinine, primary disease and catheter indwelling time. Statistical analysis: the incidence of catheter-related infections is expressed by the ratio of the number of catheterization cases to the catheter indwelling day, i.e. the case / 1000 catheter day. Statistical analysis was carried out with SPSS11.0 software. Counting data using chi-square test, P0.05 for statistical significance. The result is 1: 1. Poor living conditions, hemoglobin 90 g / L, is a risk factor for catheter-related infections in semi-permanent dialysis, P0.05.2. Sex, age, serum albumin, serum creatinine, primary disease and catheter indwelling time were not significantly correlated with the incidence of catheter-related infection in semi-permanent dialysis patients (P 0.05). Conclusion: poor living environment, 90 g / L hemoglobin, may be a risk factor for catheter-related infection.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R459.5

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