肾内科血液透析患者医院感染的特点分析  

Characteristics of nosocomial infections in patients undergoing hemodialysis in nephrology department

作　　者：晏丽云[1] 晏萍英 张竞雄[1] 

机构地区：[1]杭州市第一人民医院肾脏内科,浙江杭州310006 [2]丰城市矿务局总医院病案室,江西丰城331211

出　　处：《中华医院感染学杂志》2015年第9期2030-2032,共3页Chinese Journal of Nosocomiology

基　　金：浙江省科技厅研究基金资助项目(20130567-8)

摘　　要：目的分析肾内科血液透析患者医院感染的特点,为医院感染的预防及控制提供参考依据。方法选取了2011年5月-2013年3月肾内科接受血液透析的324例患者为调查对象,回顾性分析感染患者的临床资料,统计分析感染部位分布、影响因素以及病原菌种类等。结果 324例血液透析患者共发生医院感染52例,感染率为16.05%;感染部位以肺部、泌尿道为主,分别占32.7%和23.1%,其次依次为血管通路、腹膜炎、肠道、皮肤;共分离出病原菌44株,其中革兰阴性菌21株占47.7%,革兰阳性菌15株占34.1%,真菌8株占18.2%;年龄>60岁、静脉置导管、血红蛋白≤90g/L、血清白蛋白<30g/L、伴有糖尿病肾病是血液透析患者医院感染相关影响因素(P<0.05)。结论肾内科患者血液透析过程中发生医院感染的风险较高,对此需要在控制原发病的基础上采取有效措施进行干预,减少侵入性操作、缩短住院时间,从而有效降低病死率。OBJECTIVE To analyze the characteristics of nosocomial infections in the patients undergoing hemodial‐ysis in the nephrology department so as to provide guidance for prevention and control of the nosocomial infec‐tions .METHODS A total of 324 patients who underwent the hemodialysis in the nephrology department from May 2011 to Mar 2013 were recruited as the study objects ,then the clinical data of the patients with infections were retrospectively analyzed ,and the infection sites ,influencing factors ,and species of pathogens were statistically analyzed .RESULTS The nosocomial infections occurred in 52 of 324 patients undergoing hemodialysis ,with the in‐fection rate of 16 .05% ;the lung （32 .7% ） and urinary tract （23 .1% ） were dominant among the infection sites , followed by the blood vessel ,peritonitis ,intestinal tract ,and skin .Totally 44 strains of pathogens have been iso‐lated ,including 21 （47 .7% ） strains of gram‐negative bacteria ,15 （34 .1% ） strains of gram‐positive bacteria ,and 8 （18 .2% ） strains of fungi .The influencing factors for the nosocomial infections in the patients undergoing hemo‐dialysis included the more than 60 years of age ,venous catheter indwelling ,level of hemoglobin no more than 90 g/L ,level of serum albumin less than 30 g/L , and complication of diabetes and renal disease （ P〈0 .05 ） . CONCLUSION The patients of the nephrology department are at high risk of nosocomial infections during the process of hemodialysis ,and it is necessary to take effective interventions based on the control of primary diseases , reduce the invasive operations ,and shorten the length of hospital stay so as to reduce the mortality rate .

关 键 词：血液透析 医院感染 特点分析 

分 类 号：R181.32[医药卫生—流行病学]