中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (06): 423-426.doi: 10.3969/j.issn.1671-4091.2017.06.015

• 血管通路 • 上一篇    下一篇

尿毒症患者导管相关性血流感染的危险因素分析

方帆1,杜晓刚1   

  1. 1. 重庆医科大学附属第一医院肾内科
  • 收稿日期:2016-05-24 修回日期:2017-04-03 出版日期:2017-06-12 发布日期:2017-06-14

Risk factors for catheter-related blood stream infection in uremia patients

  • Received:2016-05-24 Revised:2017-04-03 Online:2017-06-12 Published:2017-06-14

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摘要： 目的探索终末期肾脏病(end-stage renal disease,ESRD)患者发生导管相关性血流感染(catheter-related blood stream infection，CRBSI)的相关危险因素，以期为临床预防CRBSI 提供参考和意见。方法回顾性收集2013 年1 月～2014 年12 月重庆医科大学附属第一医院收治的343 例使用中心静脉导管透析的尿毒症患者的年龄、性别、置管类型、血清总蛋白、血清白蛋白、血红蛋白、是否合并糖尿病、是否合并其他部位感染等临床资料，按是否发生CRBSI 将其分为CRBSI 组(50 例)和非CRBSI 组(293 例)，并采用SPSS21.0 软件对相关数据进行分析，认为P＜0.05 有统计学意义。结果通过比较CRBSI 组和非CRBSI 组的相关临床资料，我们发现股静脉置管较颈内静脉置管更易发生CRBSI,(χ2=19.107，P＜0.001)；临时置管较长期置管更易发生CRBSI(χ2=8.009，P=0.005)；合并其他部位感染的尿毒
症患者较未合并其他部位感染者更易发生CRBSI(χ2=4.248，P=0.039)。CRBSI 组患者的年龄较非CRBSI组低(t=-2.123，P=0.034)；CRBSI 组患者血清白蛋白水平较非CRBSI 组低(t=-2.177，P=0.030);两组研究对象在性别、是否合并糖尿病、血清总蛋白水平、血红蛋白水平上差异没有统计学意义，统计量及P 值分别为(χ2=1.662，P=0.197)、(χ2=0.004，P=0.948)、(t=- 1.530，P=0.127)、(t=- 0.846，P=0.388)。结论CRBSI 是血液透析者常见的并发症。CRBSI 的发生可能与导管类型、血清白蛋白水平、是否合并其他部位感染有关。

关键词: 血液透析, 导管相关性血流感染, 危险因素

Abstract: Objective To explore the risk factors for catheter- related bloodstream infection (CRBSI) in end-stage renal disease patients in order to provide references and suggestions for the prevention of CRBSI. Methods We recruited age, gender, type of central vein catheterization (CVC), serum albumin, serum total protein, hemoglobin, diabetes, co-infection of 343 patients (50 cases with CRBSI and 293 cases without CRBSI) using CVC for hemodialysis access during Jan. 1, 2013 to Dec. 31, 2014. Clinical data were analyzed by SPSS 21.0, and P＜0.05 was defined as statistical significance. Results After analyses of clinical data, we found that femoral vein catheterization was more susceptible to CRBSI than internal jugular vein catheterization (χ2=19.107, P＜0.001), temporary catheterization was more susceptible to CRBSI than long-term catheterization (χ2=8.009, P=0.005), and patients with co-infection were more susceptible to CRBSI than those without co-infection (χ2=4.248, P=0.039). Age was younger in the CRBSI group than in the non-CRBSI group (t=-2.123, P=0.034). Serum albumin was lower in the CRBSI group than in the non-CRBSI group (t=-2.177, P=0.030). There were no differences in gender (χ2=1.662, P=0.197), diabetes (χ2=0.004, P=0.948), serum total protein (t=- 1.530, P=0.127), and hemoglobin (t=- 0.846, P=0.388) between the two groups. Conclusions CRBSI is a common complication in hemodialysis patients. The prevalence of CRBSI may relate to the type of CVC, serum albumin and co-infection in hemodialysis patients

Key words: hemodialysis, catheter-related bloodstream infection（CRBSI）, risk factor