水胶体敷料与3M敷料对腹膜透析患者隧道管口感染的预防效果对比及导管出口处感染的危险因素分析  

Comparison of the preventive effects of hydrocolloid dressing and 3M dressing on tunnel orifice infection in peritoneal dialysis patients and analysis of the risk factors for catheter exit infection

作　　者：杨亚辉 武彦霞[2] 王玉慧[1] YANG Yahui;WU Yan-xia;WANG Yu-hui(Blood Purification Centre,Chengde Central Hospital,Chengde 067000,China;Department of Emergency,The Second Affiliated Hospital of Xingtai Medical College,Xingtai 054000,China)

机构地区：[1]承德市中心医院血液透析中心,承德067000 [2]邢台医学高等专科学校第二附属医院急诊科,邢台054000

出　　处：《中国血液净化》2021年第10期707-710,共4页Chinese Journal of Blood Purification

基　　金：河北省2020年度医学科学研究课题项目(20200346)。

摘　　要：目的探讨水胶体敷料与3M敷料对腹膜透析(peritoneal dialysis,PD)患者隧道管口感染的预防效果,并分析影响导管出口处感染的危险因素。方法选取2018年6月~2020年12月于承德市中心医院肾内科收治的154例PD患者,依据入组患者开始透析时隧道管口敷料类型分为水胶体敷料组(n=86)和3M敷料组(n=68)。比较2组患者出院前的感染控制情况以及治愈率,统计分析治愈时间、换药次数以及不良反应情况。根据患者是否存在出口处感染分为感染组、非感染组,采用Logistic回归分析导管出口处感染的危险因素。结果水胶体敷料组感染率低于3M敷料组(4.65%比14.71%),差异有统计学意义(U=2.005,P=0.045)。非感染组的管道固定不良、不依从出口护理流程、出口机械性压迫占比低于感染组(χ^(2)=6.755、4.200、5.468,P=0.009、0.040、0.019)。Logistic回归分析显示,管道固定不良(OR=1.793;95%CI:1.060~3.032,P=0.029)、敷料类型(OR=1.592;95%CI:1.065~2.379,P=0.023)均是影响导管出口处感染的危险因素。结论水胶体敷料可降低PD患者隧道管口感染发生率,利于出口处愈合,且安全性较好。护理过程中需保证管道固定位置,指导PD患者依从出口护理流程以及避免出口机械性压迫。Objective To explore the preventive effect of hydrocolloid dressing and 3M dressing on tunnel orifice infection in peritoneal dialysis(PD)patients,and to analyze the risk factors for the catheter orifice infection.Methods A total of 154 PD patients admitted to the Department of Nephrology of Chengde Central Hospital from June 2018 to December 2020 were recruited and divided into hydrocolloid dressing group(n=86)and 3M dressing group(n=68)according to the type of tunnel orifice dressing at the time the dialysis started.The infection control rate and cure rate before discharge from the hospital were compared between the two groups.The cure time,the number of dressing changes and adverse reactions were analyzed.Patients were also divided into infection group and non-infection group according to the situation of tunnel orifice infection.Logistic regression was used to analyze the risk factors for tunnel orifice infection.Results The infection rate was statistically lower in the hydrocolloid dressing group than in the 3M dressing group(4.65%vs.14.71%;U=2.005,P=0.045).The proportions of poor tube fixation,incompliance with orifice care procedures and orifice mechanical compression were significantly lower in the non-infection group than in the infection group(χ^(2)=6.755,4.200 and 5.468 respectively;P=0.009,0.040 and 0.019 respectively).Logistic regression showed that poor fixation of the tube(OR=1.793,95%CI:1.060~3.032,P=0.029)and dressing type(OR=1.592,95%CI:1.065~2.379,P=0.023)were the risk factors for tunnel orifice infection.Conclusion The hydrocolloid dressing reduced the incidence of tunnel orifice infection in PD patients and facilitated healing of the infection with safety.Careful should be paid to fix the PD tube,to guide the patients following the orifice nursing processes,and to avoid mechanical pressure on the orifice during nursing PD patients.

关 键 词：水胶体敷料 3M敷料 腹膜透析 隧道管口感染 肾病 

分 类 号：R473[医药卫生—护理学]