腹膜透析患者居家环境和腹膜炎关系研究  

Relationship between home environment and peritonitis in patients with peritoneal dialysis

作　　者：叶元君[1] 张晓辉 刘延苏[1] 楼宏青[1] 寿张飞 

机构地区：[1]义乌市中心医院肾内科,322000 [2]浙江大学医学院附属第一医院肾脏病中心 [3]浙江大学国际医院肾脏病科

出　　处：《浙江医学》2017年第14期1198-1202,共5页Zhejiang Medical Journal

基　　金：国家自然科学基金(81170707);国家和浙江省卫生和计划生育委员会联合研究基金(wkj-zj-1610)

摘　　要：目的探讨腹膜透析(PD)患者居家环境和PD相关性腹膜炎的关系,并分析引起环境不达标的危险因素。方法对义乌市辖区内86例PD患者进行家访,按既往PD相关性腹膜炎发生史将患者分为初发腹膜炎组(19例)与未发腹膜炎组(67例);自设调查表,对居家环境进行现场评分,按得分情况将患者分为居家环境合格组(47例)和居家环境不合格组(39例);按医院Ⅲ类环境标准对换液间环境(空气和桌面)进行细菌采样培养。结果与未发腹膜炎组相比,初发腹膜炎组患者透析龄较长,个人年经济收入较低,本人操作比例较高(均P<0.05);透析龄长、个人年经济收入低是腹膜炎发生的独立危险因素。居家环境合格组、居家环境不合格组患者个人年经济收入、工作状况、腹膜炎发生率等方面比较差异有统计学意义(均P<0.05);个人年经济收入低是患者居家环境不合格的独立危险因素。换液间采样培养结果以溶血性葡萄球菌、表皮葡萄球菌等凝固酶阴性葡萄球菌为主,空气灰尘大、紫外线灯强度不合格是换液间环境不达标的独立危险因素。结论对居家环境不合格、经济条件欠佳的PD患者,应加强透析间环境的维护,有针对性地进行家访,有助于降低腹膜炎发生风险。Objective To investigate the relationship between home environment and peritoneal dialysis （PD） related peritonitis, and the risk factors of unqualified home environment. Methods Eighty six patients with PD in Yiwu city were enrolled in the study, among whom PD-related peritonitis had occurred in 19 cases （peritonitis group） and had not in 67 cases （control group） according to the previous history. The home environment was scored by SOP set questionnaire, the home environment was qualified in 47 cases and home environment was unqualified in 39 cases. The samples from air and desktop were taken and bacteria cultures were performed according to the hospital environmental standards on class III. Results Compared to control group, peritonitis patients had a longer dialysis duration, a lower personal income, and a higher proportion of doing PD by themselves （P〈0.05）. Long dialysis duration and low personal income were independent risk factors of peritonitis. There were significant differences in personal income, working conditions, and incidence of peritonitis between patients with qualified home environment and those with unqualified home environment （P〈0.05）. Low personal income was the independent risk factor of patients with unqualified home environment. The results of bacteria cultures were hemolytic Staphylococcus aureus, Staphylococcus epidermidis and coagulase negative staphylococci. Air dust, unqualified ultraviolet light intensity were independent risk factors for positive bacterial cultures. Conclusion For PD patients with poor home environment and low income, maintenance of the PD environment and targeted home visits should be strengthened, which would reduce the risk of PD-related peritonitis.

关 键 词：腹膜透析 环境 腹膜炎 紫外线 家访 

分 类 号：R459.5[医药卫生—治疗学] R572.2[医药卫生—临床医学]