【摘要】：目的觀察老年慢性腎衰竭患者置入半永久導(dǎo)管后行維持性血液透析期間導(dǎo)管相關(guān)感染的臨床特征及危險因素。方法回顧性分析留置半永久導(dǎo)管行維持性血液透析的老年患者病例資料,共納入79例慢性腎衰竭患者。記錄半永久導(dǎo)管出口部感染、隧道感染、導(dǎo)管相關(guān)菌血癥等導(dǎo)管相關(guān)感染情況。將出現(xiàn)感染的患者納入感染組,其他患者納入未感染組,比較兩組性別、平均年齡、平均透析時間、導(dǎo)管留置時間、有無糖尿病、高血壓等臨床特征,Cox比例風(fēng)險回歸分析半永久導(dǎo)管后進行維持性血液透析期間感染的影響因素。結(jié)果入選患者均保持隨訪1年以上,平均(21.5±8.2)個月,79例置管患者共發(fā)生半永久導(dǎo)管相關(guān)感染事件者21例(26.6%),其中置管出口部感染11例,隧道感染8例,導(dǎo)管相關(guān)菌血癥2例。細(xì)菌分布:革蘭陽性球菌12株(57.1%),其中金黃色葡萄球菌[7株(33.3%)]、表皮葡萄球菌[4株(19.0%)]常見;革蘭陰性桿菌8株(38.1%),以大腸埃希菌[3株(14.3%)]、銅綠假單跑菌[3株(14.3%)]常見;真菌1株(4.8%)。感染組平均年齡、平均透析時間、平均導(dǎo)管留置時間、合并糖尿病比例、合并低白蛋白血癥比例均顯著高于未感染組(P0.05);而兩組性別、有無合并高血壓無顯著差異(P0.05)。進一步行Cox比例風(fēng)險回歸分析,合并糖尿病(OR=4.211,P=0.001)、半永久導(dǎo)管留置時間(OR=2.910,P=0.003)、低蛋白血癥(OR=1.340,P=0.019)是半永久導(dǎo)管相關(guān)感染的危險因素,而平均年齡、平均透析時間對半永久導(dǎo)管相關(guān)感染影響較小(P0.05)。結(jié)論老年慢性腎衰竭使用半永久導(dǎo)管行血液透析的患者以置管出口部、隧道感染多見,致病菌以革蘭陽性球菌為主,合并糖尿病、半永久導(dǎo)管留置時間、低白蛋白血癥是感染的危險因素。
[Abstract]:Objective to investigate the clinical characteristics and risk factors of catheter-related infection in elderly patients with chronic renal failure (CRF) during maintenance hemodialysis. Methods the data of 79 patients with chronic renal failure were analyzed retrospectively. To record the infection of semi-permanent catheter, tunnel infection, ductal-associated bacteremia and so on. The patients with infection were included in the infected group, and the other patients were included in the non-infected group. The sex, average age, mean dialysis time, catheter retention time, diabetes mellitus and hypertension were compared between the two groups. Cox proportional risk regression analysis was used to analyze the risk factors of infection during maintenance hemodialysis after semi-permanent catheter. Results all the patients were followed up for more than one year, with an average of (21.5 鹵8.2) months. There were 21 cases (26.6%) with semi-permanent catheter-related infection in 79 patients with catheterization. 2 cases with ductal associated bacteremia. Bacterial distribution: Gram-positive cocci 12 (57.1%), Staphylococcus aureus [7 (33.3%)], Staphylococcus epidermidis [4 (19.0%)]; Gram-negative bacilli were found in 8 strains (38.1%), Escherichia coli [3 strains (14.3%)], Pseudomonas aeruginosa (3 strains (14.3%) and fungi in 1 strain (4.8%). The average age, mean dialysis time, mean catheter indwelling time, the proportion of diabetes mellitus and hypoalbuminemia in the infection group were significantly higher than those in the uninfected group (P0.05). There was no significant difference between the two groups (P0.05). Further Cox proportional risk regression analysis, diabetes mellitus (OR=4.211,P=0.001), semi-permanent catheter indwelling time (OR=2.910,P=0.003), hypoproteinemia (OR=1.340,) P0. 019) was the risk factor of semi-permanent catheter-related infection, but the average age and mean dialysis time had little effect on semi-permanent catheter-related infection (P0.05). Conclusion in the elderly patients with chronic renal failure who underwent hemodialysis with semi-permanent catheter, there were more tunnel infections, Gram-positive cocci as the main pathogens, diabetes mellitus and semi-permanent catheter indwelling time. Hypoalbuminemia is a risk factor for infection.
【作者單位】： 武昌醫(yī)院腎病學(xué)科;
【分類號】：R692.5

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