新型冠状病毒感染流行期与非流行期血液透析患者血管通路感染发生率比较  

Comparison of vascular access infection incidence of hemodialysis patients during epidemic and non-epidemic period of COVID-19

作　　者：张冰 史灵芝 化俊飞 茅一萍 ZHANG Bing;SHI Lingzhi;HUA Junfei;MAO Yiping(Department of Infection Management,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangshu 221000,P.R.China;Department of Blood Purification Center,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangshu 221000,P.R.China)

机构地区：[1]徐州医科大学附属医院感染管理科,江苏徐州221000 [2]徐州医科大学附属医院血液净化中心,江苏徐州221000

出　　处：《华西医学》2023年第12期1874-1879,共6页West China Medical Journal

基　　金：国家卫生健康委医院管理研究所“感·动中国”医疗机构感染预防与控制科研项目(GY202023-A)。

摘　　要：目的探究新型冠状病毒感染流行期(以下简称流行期)较无本土新型冠状病毒感染期(以下简称对照期)血液透析患者血管通路感染发生率变化。方法本研究为单中心回顾性研究。选择2022年12月7日—2023年2月23日流行期与2020年12月7日—2021年2月23日对照期在徐州医科大学附属医院血液净化中心接受血液透析的成年患者。观察比较纳入患者的血管穿刺部位感染(local access site infection,LASI)和血管通路相关血流感染(access related bloodstream infection,ARBSI)的发生情况。结果共纳入患者1401例。其中,流行期737例,对照期664例。不同时期和通路类型患者的年龄、性别、置管时长比较,差异均无统计学意义(P>0.05)。流行期和对照期发生LASI比较,差异无统计学意义(χ^(2)=1.800,P=1.180)。流行期和对照期发生ARBSI比较,差异有统计学意义[χ^(2)=4.610,相对危险度(relative risk,RR)=2.575,95%置信区间(confidence interval,CI)(1.053,6.298),P=0.032]。动静脉瘘患者、带隧道和涤纶套的透析导管(tunnel-cuffed catheters,TCC)患者在不同时期的LASI、ARBSI发生率比较,差异均无统计学意义(P>0.05);无隧道和涤纶套的透析导管(non cuffed catheters,NCC)患者在不同时期的LASI[χ^(2)=4.898,RR=3.832,95%CI(1.058,13.885),P=0.027]、ARBSI[χ^(2)=7.150,RR=4.684,95%CI(1.333,16.460),P=0.005]发生率比较,差异均有统计学意义。与动静脉瘘患者,TCC患者在流行期可能发生LASI(P<0.05),在对照期可能发生ARBSI(P<0.05);中心静脉导管患者和NCC患者在对照期均可能发生LASI和ARBSI(P<0.05)。结论针对新型冠状病毒感染的感染防控措施可降低血液透析患者尤其是NCC患者发生血管通路感染的风险。Objective To explore the vascular access infection(VAI)incidence of hemodialysis patients during the the maximum spread of the COVID-19 epidemic(epidemic period)compared with the corresponding period with no local cases of COVID-19(control period).Methods A single-center,retrospective study was carried out.Adult patients who underwent hemodialysis at the Department of Blood Purification Center,the Affiliated Hospital of Xuzhou Medical University during the epidemic period between December 7,2022 and February 23,2023 and the control period between December 7,2020 and February 23,2021 were selected.The incidence of local access site infection(LASI)and access related bloodstream infection(ARBSI)in included patients were observed and compared.Results A total of 1401 patients were included.Among them,there were 737 cases during the epidemic period and 664 cases during the control period.There was no statistically significant difference in the age,gender,and duration of catheterization among patients of different periods and pathway types(P>0.05).There was no statistically significant difference in the occurrence of LASI between the epidemic period and the control period(χ^(2)=1.800,P=1.180).There was a statistically significant difference in the occurrence of ARBSI between the epidemic period and the control period[χ^(2)=4.610,relative risk(RR)=2.575,95%confidence interval(CI)(1.053,6.298),P=0.032].There was no statistically significant difference in the incidence of LASI and ARBSI at different stages in patients with arteriovenous fistula and unnel-cuffed catheters(TCC)(P>0.05).There were statistically significant differences in the incidence of LASI[χ^(2)=4.898,RR=3.832,95%CI(1.058,13.885),P=0.027]and ARBSI[χ^(2)=7.150,RR=4.684,95%CI(1.333,16.460),P=0.005]among non cuffed catheters(NCC)patients at different stages.TCC patients might experience LASI(P<0.05)during the epidemic period and ARBSI(P<0.05)during the control period compared with the arteriovenous fistula patients;both central venous catheterization and

关 键 词：新型冠状病毒感染 血液透析 血管通路相关血流感染 血管穿刺部位感染 

分 类 号：R692.5[医药卫生—泌尿科学] R511[医药卫生—外科学]