老年慢性肾衰竭患者半永久导管相关感染的临床特征及危险因素

发布时间：2018-11-25 18:29

【摘要】：目的观察老年慢性肾衰竭患者置入半永久导管后行维持性血液透析期间导管相关感染的临床特征及危险因素。方法回顾性分析留置半永久导管行维持性血液透析的老年患者病例资料,共纳入79例慢性肾衰竭患者。记录半永久导管出口部感染、隧道感染、导管相关菌血症等导管相关感染情况。将出现感染的患者纳入感染组,其他患者纳入未感染组,比较两组性别、平均年龄、平均透析时间、导管留置时间、有无糖尿病、高血压等临床特征,Cox比例风险回归分析半永久导管后进行维持性血液透析期间感染的影响因素。结果入选患者均保持随访1年以上,平均(21.5±8.2)个月,79例置管患者共发生半永久导管相关感染事件者21例(26.6%),其中置管出口部感染11例,隧道感染8例,导管相关菌血症2例。细菌分布:革兰阳性球菌12株(57.1%),其中金黄色葡萄球菌[7株(33.3%)]、表皮葡萄球菌[4株(19.0%)]常见;革兰阴性杆菌8株(38.1%),以大肠埃希菌[3株(14.3%)]、铜绿假单跑菌[3株(14.3%)]常见;真菌1株(4.8%)。感染组平均年龄、平均透析时间、平均导管留置时间、合并糖尿病比例、合并低白蛋白血症比例均显著高于未感染组(P0.05);而两组性别、有无合并高血压无显著差异(P0.05)。进一步行Cox比例风险回归分析,合并糖尿病(OR=4.211,P=0.001)、半永久导管留置时间(OR=2.910,P=0.003)、低蛋白血症(OR=1.340,P=0.019)是半永久导管相关感染的危险因素,而平均年龄、平均透析时间对半永久导管相关感染影响较小(P0.05)。结论老年慢性肾衰竭使用半永久导管行血液透析的患者以置管出口部、隧道感染多见,致病菌以革兰阳性球菌为主,合并糖尿病、半永久导管留置时间、低白蛋白血症是感染的危险因素。
[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 卤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.
【作者单位】：武昌医院肾病学科;
【分类号】：R692.5

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