血液透析半永久透析导管相关性感染危险因素的分析

发布时间：2018-11-16 08:37

【摘要】：目的:分析血液透析半永久透析导管相关性感染的危险因素。方法:选取2011.12-2014.12威海404医院肾内科就诊的留置半永久透析导管的患者29例。28例采用右颈内静脉置管术,1例采用左颈内静脉置管术(右颈内静脉畸形、狭窄)。以上患者采用seldinger技术进行穿刺和撕脱鞘导管置入法。根据导管相关性感染的诊断标准:①出口部感染:导管出口处2cm以内范围内的皮肤发红、肿胀、疼痛、有脓性分泌物或者分泌物培养阳性,有或者无血流感染。②隧道感染:感染沿着导管口及导管置入方向继续感染超过2cm。可有局部隧道部位的疼痛、肿胀、发热,沿导管口挤压后可能有脓性分泌物流出,伴或者不伴有血流感染,分泌物培养阳性。③导管相关性菌血症(CRB)的表现:透析过程中出现寒战、发热,部分患者免疫力低下,仅表现为低热、低血压、低血糖等。确诊标准:导管内血培养呈阳性,导管内血培养的菌落数大于100cfu/ml,导管内及外周血培养为同一细菌,导管血培养细菌数为外周血细菌数的5倍。将以上29人分为导管相关性感染组(感染组)及无导管相关性感染组(非感染组)。分析年龄、性别、生活环境、血红蛋白、血白蛋白、血肌酐、原发病、导管留置时间等与导管相关性感染的相关性。统计学处理:导管相关性感染的发生率用导管感染的例次与导管留置日的比来表示,即例次/1000导管日。用SPSS11.0软件进行统计学分析。计数资料采用卡方检验,P0.05为具有统计学意义。结果:1.生活环境差、血红蛋白90g/L,是半永久透析导管相关性感染的危险因素,P0.05.2.性别、年龄、血白蛋白、血肌酐、原发疾病、导管留置时间等单因素与半永久透析导管相关感染的发生率无明显相关,P0.05.结论:生活环境差、血红蛋白90g/L,可能是导管相关性感染的危险因素。
[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.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.5

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