湖南省腹膜透析腹膜炎发病率城乡对比以及影响因素探讨

发布时间：2017-12-28 08:01

本文关键词：湖南省腹膜透析腹膜炎发病率城乡对比以及影响因素探讨　出处：《湖南师范大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究背景:终末期肾病(end-stage renal disease,ESRD)是指各种慢性肾脏病(Chronic kidney disease,CKD)的终末阶段,在临床中,肾功能达到CKD5期即进入了终末期肾病[1]。大多数终末期肾脏病患者在血液透析(hemodialysis,HD)中心进行血透治疗,而在家庭透析治疗中,腹膜透析(peritoneal dialysis,PD)则占主导地位。至2012年,全球PD人数占总透析人数11%[2]。在2011年底,我国有2.7万余例患者进行腹膜透析治疗,而在2012年底,腹膜透析人数已达到3.8万余例,占透析总人数的13%[3]。PD因其自身的一些特点和优点,例如所需设备简单,易于操作;对血容量影响较小,不增加心脏负荷;保护残余肾功能[4],现在腹膜透析被越来越多的人们所接受。腹膜透析相关性腹膜炎是腹膜透析治疗中最常见和严重的并发症之一,是导致腹膜透析患者拔管,退出腹膜透析治疗最主要的原因[5],同时腹膜炎的发生会使腹膜功能下降,影响患者生存率[6]。此外,腹膜炎的发生也会在一定程度上增加患者的经济负担,并且会对患者的生活质量产生严重的影响。近年来,随着透析管路和透析液不断改进,透析技术日益成熟,腹膜透析相关性腹膜炎发病率明显下降,但它仍是引起患者住院、不能坚持腹膜透析的主要原因[7]。目前我国处于社会主义初级阶段,城乡发展不平衡,城乡腹膜透析患者在地理环境、家庭卫生条件、个人教育、个人卫生习惯、疾病的认知能力、实际无菌操作过程等方面存在区别,腹膜炎发病率可能存在着城乡区别。本文通过调查湖南省三个腹透中心,城乡PD患者腹膜炎发生率,明确两者是否存在区别,并进一步探讨腹膜炎发生的可能影响因素,期望通过针对相关影响因素进行腹膜炎的预防,达到减少腹膜炎的目的,提高腹膜透析患者生活质量,减少透析失败的风险。目的:调查湖南省城乡腹膜透析腹膜炎的发病率,明确两者是否存在区别,并进一步探讨腹膜炎发生的可能影响因素,以期为临床筛选出腹膜炎发病的高危人群,并期望通过针对相关危险因素进行腹膜炎的预防,从而减少腹膜炎的发生。方法:选取2013年1月至2014年12月在湖南省人民医院、湘雅三医院、邵阳市中心医院三个大型腹膜透析中心capd患者,作为研究对象,一共纳入1374名患者。根据患者长期居住地情况,分为城市组与农村组。计算各腹透中心及总的城乡腹膜炎发生率,分析两者是否存在区别。另根据患者是否发生腹膜炎,分为腹膜炎组与非腹膜炎组,采用随机抽样方法,各抽取200例患者进行问卷调查,分析腹膜炎发生的可能危险因素。若城乡腹膜炎发生率有差异,随机抽样城市组与农村组患者各200例进行问卷调查,分析造成城乡腹膜炎差异的可能影响因素。记录capd患者一般资料(性别、年龄、居住地、文化程度等),状态(在透、转血透、死亡、移植),腹膜炎次数,操作情况,个人卫生情况,腹泻便秘等情况。用spss22.0软件建立数据库,计量资料使用均数±标准差,采用t检验,计数资料使用频数记录,采用χ2检验,logistic多因素回归分析影响因素。结果:1.城乡两组患者在性别、年龄上比较,差异无统计学意义(p0.05),城市腹膜炎发生率为0.19次/患者年(即1/62个患者月),农村腹膜炎发生率为0.28次/患者年(即1/42个患者月),差异具有统计学意义(p0.05),农村腹膜炎发病率高于城市。2.腹膜炎与一般资料分析:腹膜炎组与非腹膜炎组在长期居住地上比较,差异具有统计学意义(p0.05),长期居住地为农村的患者发生腹膜炎风险高于城市患者,而在性别、年龄、体重指数、文化程度上比较,差异无统计学意义(p0.05)。3.腹膜炎与合并糖尿病分析:腹膜炎组与非腹膜炎组在是否合并糖尿病上比较,差异具有统计学意义(p0.05),合并糖尿病的患者腹膜炎发生率较未合并糖尿病患者高。4.腹膜炎与操作情况分析:腹膜炎组与非腹膜炎组在是否有固定换液房间、换液前洗手、戴口罩、碘伏帽使用、紫外线灯使用上比较,差异具有统计学意义(p0.05),没有固定换液房间、换液前不洗手、不戴口罩、碘伏帽重复使用,操作台没有紫外线灯消毒的患者腹膜炎发生率高于有固定换液房间、换液前洗手、戴口罩、碘伏帽一次性使用、有紫外线灯消毒的患者。5.腹膜炎与个人卫生习惯分析:腹膜炎组与非腹膜炎组在洗手频率、刷牙频率、夏天洗澡频率上比较,差异具有统计学意义(p0.05),洗手频率、刷牙频率、夏天洗澡频率低的患者腹膜炎发生率高于洗手频率、刷牙频率、夏天洗澡频率高的患者。而在换牙刷频率、晒洗被褥频率、剪指甲频率、灰指甲或手足癣上比较,差异无统计学意义(p0.05)。6.腹膜炎与肠道情况分析:两组在腹泻、便秘上比较,差异具有统计学意义(p0.05),有腹泻或便秘情况的患者腹膜炎发生率高于没有腹泻便秘情况的患者。7.Logistic回归方程分析:患者长期居住地、洗手次数、刷牙次数、腹泻及便秘对回归方程有统计学意义(p0.05),居住地为农村的患者发生腹膜炎的风险是城市的5.876倍,平时洗手3到5次的患者发生腹膜炎的风险是洗手次数达10次以患者的5.961倍,每天刷牙小于等于1次的患者发生腹膜炎的风险是刷牙大于等于2次患者的3.947倍,存在腹泻的患者发生腹膜炎的风险是没有腹泻患者的5.744倍,存在便秘的患者发生腹膜炎的风险是没有便秘患者的2.021倍。8.造成城乡腹膜炎差异的可能因素分析:城乡两组在文化程度、是否合并糖尿病、洗手次数、刷牙次数上比较,差异具有统计学意义(p0.05)。城市患者文化程度高于农村患者,合并糖尿病多于农村患者,洗手及刷牙次数多于农村患者。而在一般资料及腹泻便秘上比较,差异无统计学意义(p0.05)。结论:1.湖南省腹膜透析腹膜炎发病率存在城乡区别,农村腹膜炎发病率高于城市,农村腹膜炎发病率为0.28次/患者年(即1/42个患者月),城市腹膜炎发病率为0.19次/患者年(即1/62个患者月),农村患者发生腹膜炎风险是城市患者的5.876倍;2.合并糖尿病、腹透操作不规范、卫生习惯差、腹泻及便秘是腹膜炎发生的危险因素;3.城乡腹膜炎差异可能与城乡患者文化程度、合并糖尿病、洗手次数、刷牙次数不同有关。
[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
【学位授予单位】：湖南师范大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R692.5

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