老年腹膜透析患者导管出口处感染的特点及危险因素分析  

Prevalence and risk factors of exit-site infection in elderly peritoneal dialysis patients

作　　者：林建雄[1] 梁碧宁[1] 鲁树超 吕珊 于晓丽[1] 毛海萍[1] 余学清[1] 阳晓[1] Lin Jianxiong;Liang Bining;Lu Shuchao;Lyu Shan;Yu Xiaoli;Mao Haiping;Yu Xueqing;Yang Xiao(Department of Nephrology,the First Affiliated Hospital,Sun Yat-sen University,Key Laboratory of Nephrology,Ministry of Health,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院肾内科卫生部重点实验室,广州510080

出　　处：《中华肾脏病杂志》2020年第6期417-423,共7页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81774069);国家重点研发项目(2016YFC0906101);广东省重点实验室运行经费(2017B030314019);广东省医学科学基金(A2017054);广东省科技计划(2017B020227006);广州市科技计划项目(201704020167)。

摘　　要：目的探讨老年腹膜透析(腹透)患者导管出口处感染的特点及危险因素。方法纳入2009年1月至2013年12月在本中心置管的年龄≥60岁的腹透患者,前瞻随访1年或期间退出腹透。根据患者是否存在出口处感染分为感染组和非感染组。收集患者人口学、实验室指标及出口处护理等资料。结果本研究纳入247例患者,年龄(68.6±6.2)岁,男性占53.4%,糖尿病肾病者占48.2%,中位随访时间为12.0个月。32例(13.0%)患者发生34次出口处感染,感染率为82.5患者月/次(0.15次/患者年)。凝固酶阴性葡萄球菌是最主要致病菌(35.3%)。培养阴性率为8.8%。导管出口处评估结果显示,不依从护理流程者23.5%,腹透管固定不良者62.3%,管道牵扯史者9.7%,出口处有机械性压迫者5.3%,护理频率不当者29.6%,用莫匹罗星者13.8%,患者本人护理出口处者26.7%,更换出口处护理者16.6%。两组患者的人口学(年龄、性别、基础肾脏病等)及实验室指标(血红蛋白、白蛋白、血钾等)的差异无统计学意义。多因素Cox回归分析显示,不依从出口处护理流程(HR=2.352,95%CI 1.008~5.488,P=0.048)、腹透管固定不良(HR=3.074,95%CI 1.046~9.035,P=0.041)及出口处护理者不固定(HR=2.423,95%CI 1.004~5.845,P=0.049)是出口处感染的独立危险因素。结论老年腹透患者的出口处感染率为0.15次/患者年。教育患者依从出口处护理流程、做好腹透管固定及由固定的经培训的护理者护理出口处可能会降低老年腹透患者导管出口处感染。Objective To explore the prevalence and risk factors of exit-site infection(ESI)in elderly peritoneal dialysis(PD)patients.Methods The status of exit-site was evaluated in elderly PD patients(≥60 years)who had catheter insertion in our center between January 1,2009 and December 31,2013,with follow-up for 1 year or withdrawing from peritoneal dialysis in this period.The patients were divided into ESI and non-ESI group.The data was collected including demographics,clinical features,and nursing care methods of the exit-site.Results A total of 247 patients were recruited in this study,aged(68.6±6.2)years,among whom there were 132 male(53.4%)and 119 diabetes(48.2%).Median follow-up time was 12.0 months.Thirty-two patients had 34 episodes of ESI with a rate of 82.5 patient-months per episode(0.15 episodes per year).Coagulase-negative Staphylococcus was the main pathogen,accounting for 35.3%of the ESI.No bacterial growth was found in 8.8%.The exit-site nursing care status included that poor compliance of exit-site care 23.5%,poor catheter immobilization 62.3%,history of catheter-pulling injury 9.7%,mechanical stress on exit-site 5.3%,improper frequency of nursing care 29.6%,mupirocin usage 13.8%,patients taking exit-site care 26.7%,exit-site caregiver instability 16.6%.There were no differences in demographic(such as age,gender,primary disease,etc)and laboratory data(hemoglobin,serum albumin,blood potassium,etc)between the ESI and non-ESI groups.Poor compliance with exit-site care(HR=2.352,95%CI 1.008-5.488,P=0.048),poor catheter immobilization(HR=3.074,95%CI 1.046-9.035,P=0.041)and exit-site caregiver instability(HR=2.423,95%CI 1.004-5.845,P=0.049)were significantly correlated with increased risk of ESI.Conclusions The prevalence of ESI in elderly PD patients was 0.15 episodes per year.Educating PD patients to improve the compliance with exit-site care,maintain catheter immobilization and do exit-site care by a stable and trained caregiver may reduce ESI events in elderly PD patients.

关 键 词：腹膜透析 感染 导管 留置 危险因素 老年患者 

分 类 号：R473.5[医药卫生—护理学]