尿毒症血液透析患者医源性交叉感染状况调查  

Latrogenic Cross Infection between Hemodialysis Patients

作　　者：林国跃 张辉 杜小璐 杨建萍 张雅楠 单金晶 张玉强 韦潇睿 

机构地区：[1]解放军第四七四医院输血科,乌鲁木齐830013 [2]解放军第四七四医院血液净化中心

出　　处：《解放军预防医学杂志》2017年第3期209-212,共4页Journal of Preventive Medicine of Chinese People's Liberation Army

基　　金：兰州军区医药卫生科研计划项目(No.CLZ15JB26)

摘　　要：目的调查某医院血液净化中心维持性血液透析患者HBV、HCV、HIV、TP交叉感染情况,为临床防控提供科学依据。方法采用前瞻性设计,对近8年内133例血液透析患者进行不同层次分组透析,使用两种方法连续检测比对,数据采用t检验和χ2检验处理分析。结果 (1)133例维持性血液透析患者感染HBV 17例(12.78%)、HCV 22例(16.54%)、HBV和HCV混合感染2例(1.50%)、TP 2例,无HIV感染者。(2)HBV和HCV感染主要集中在移植性肾病、慢性肾炎、糖尿病肾病等患者中,二者感染率与在感染区透析关系密切,其中HCV感染率与移植性肾病相关、与输血史相关(P<0.05);而HBV感染与输血史未见明显关联(P>0.05),但透析后明显高于透析前(P<0.05)。(3)连续对应检测近3年127例透析患者,仅有1例HBs Ag指标转为阳性,未发生HCV、HIV、TP新的交叉感染。结论 HCV感染与移植性肾病、输血史、移植次数高度有关,HBV感染存在透析后交叉感染的风险。血液净化中心严格按照《血液净化标准操作规程》认真操作,维持性血液透析患者的医源性交叉感染将明显减少。Objective To investigate HBV, HCV, HIV, TP cross-infection between hemodialysis patients at a blood pur- ification center and to provide reference for prevention and treatment. Methods A prospective design was used. Two methods were adopted to compare the effect of hemodialysis in 133 cases ofpatients receiving different modes of dialysis over the past eight years. The data was analyzed with t test andA7 test. Results （1） Among the 133 cases of hemodialysis patients, there were 17 cases of HBV infection（ 12.78% ） , 22 cases of HCV infection（ 16.54% ） , 2 casesof mixed infection （ 1.50% ）, and 2 cases of TP without HIV infection. （2） HBV and HCV infections were dominating among patients with transplant nephropathy, chronic nephritis, and diabetic nephropathy, and were closely related to both infection and dialysis in the affected area. HCV infection was linked to transplant nephropathy and the history of blood transfusion （P〈0.05） , while HBV infection was not linked to the history of blood transfusion （P〉0.05）, but the rate of infection was significantly higher after dialysis （ P〈0.05 ）. （3） HBsAg index of only one case turned positive, and no cross-infection between HCV, HIV, and TP occurred. Conclusion HCV infection is significantly correlated with transplant nephropathy, history of blood transfusion, and times of transplantation while HBV infec- tion is at the risk of cross infection after dialysis. Blood purification centers should comply with the Blood Purification Protocol in order to significantly reduce latrogenic cross-infection between maintenance hemodialysis patients .

关 键 词：尿毒症 血液净化 透析 医源性感染 乙型肝炎病毒 丙型肝炎病毒 人免疫缺陷病毒 梅毒 

分 类 号：R512.62[医药卫生—内科学] R459.5[医药卫生—临床医学]