【摘要】：目的:分析血液透析半永久透析導(dǎo)管相關(guān)性感染的危險(xiǎn)因素。方法:選取2011.12-2014.12威海404醫(yī)院腎內(nèi)科就診的留置半永久透析導(dǎo)管的患者29例。28例采用右頸內(nèi)靜脈置管術(shù),1例采用左頸內(nèi)靜脈置管術(shù)(右頸內(nèi)靜脈畸形、狹窄)。以上患者采用seldinger技術(shù)進(jìn)行穿刺和撕脫鞘導(dǎo)管置入法。根據(jù)導(dǎo)管相關(guān)性感染的診斷標(biāo)準(zhǔn):①出口部感染:導(dǎo)管出口處2cm以內(nèi)范圍內(nèi)的皮膚發(fā)紅、腫脹、疼痛、有膿性分泌物或者分泌物培養(yǎng)陽(yáng)性,有或者無(wú)血流感染。②隧道感染:感染沿著導(dǎo)管口及導(dǎo)管置入方向繼續(xù)感染超過(guò)2cm。可有局部隧道部位的疼痛、腫脹、發(fā)熱,沿導(dǎo)管口擠壓后可能有膿性分泌物流出,伴或者不伴有血流感染,分泌物培養(yǎng)陽(yáng)性。③導(dǎo)管相關(guān)性菌血癥(CRB)的表現(xiàn):透析過(guò)程中出現(xiàn)寒戰(zhàn)、發(fā)熱,部分患者免疫力低下,僅表現(xiàn)為低熱、低血壓、低血糖等。確診標(biāo)準(zhǔn):導(dǎo)管內(nèi)血培養(yǎng)呈陽(yáng)性,導(dǎo)管內(nèi)血培養(yǎng)的菌落數(shù)大于100cfu/ml,導(dǎo)管內(nèi)及外周血培養(yǎng)為同一細(xì)菌,導(dǎo)管血培養(yǎng)細(xì)菌數(shù)為外周血細(xì)菌數(shù)的5倍。將以上29人分為導(dǎo)管相關(guān)性感染組(感染組)及無(wú)導(dǎo)管相關(guān)性感染組(非感染組)。分析年齡、性別、生活環(huán)境、血紅蛋白、血白蛋白、血肌酐、原發(fā)病、導(dǎo)管留置時(shí)間等與導(dǎo)管相關(guān)性感染的相關(guān)性。統(tǒng)計(jì)學(xué)處理:導(dǎo)管相關(guān)性感染的發(fā)生率用導(dǎo)管感染的例次與導(dǎo)管留置日的比來(lái)表示,即例次/1000導(dǎo)管日。用SPSS11.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。計(jì)數(shù)資料采用卡方檢驗(yàn),P0.05為具有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.生活環(huán)境差、血紅蛋白90g/L,是半永久透析導(dǎo)管相關(guān)性感染的危險(xiǎn)因素,P0.05.2.性別、年齡、血白蛋白、血肌酐、原發(fā)疾病、導(dǎo)管留置時(shí)間等單因素與半永久透析導(dǎo)管相關(guān)感染的發(fā)生率無(wú)明顯相關(guān),P0.05.結(jié)論:生活環(huán)境差、血紅蛋白90g/L,可能是導(dǎo)管相關(guān)性感染的危險(xiǎn)因素。
[Abstract]:Objective: to analyze the risk factors of catheter-associated infection in hemodialysis. Methods: Twenty-nine patients with semi-permanent dialysis catheter were selected from Department of Nephrology, Weihai 404 Hospital from January 12 to December 2014.28 cases were treated with right internal jugular vein catheterization, 1 case with left internal jugular vein catheterization (malformation of right internal jugular vein, stenosis). Seldinger technique was used for puncture and avulsion catheter placement. According to the diagnostic criteria of catheter-related infection: 1Exporting infection: the skin within 2cm at the outlet of the catheter is redness, swelling, pain, and positive for purulent secretion or secretion culture. With or without bloodstream infection. 2 Tunnel infection: infection continues to infect more than 2 cm along the catheter orifice and catheter placement. There may be pain, swelling, fever at the local tunnel site, and there may be purulent discharge of secretions, with or without blood flow infection, after pressing along the duct orifice. Secretion culture was positive. 3 the manifestation of (CRB): shivering, fever, low immunity in some patients, only low fever, hypotension, hypoglycemia and so on. The positive rate of blood culture was positive in ductal blood culture. The colony number of blood culture in catheter was more than 100 cfur / ml. The bacteria cultured in catheter and peripheral blood were the same bacteria, and the number of bacteria cultured in catheter blood was 5 times of that in peripheral blood. The above 29 patients were divided into two groups: catheter associated infection group (infection group) and non-catheter-associated infection group (non-infection group). To analyze the correlation between age, sex, living environment, hemoglobin, serum albumin, serum creatinine, primary disease and catheter indwelling time. Statistical analysis: the incidence of catheter-related infections is expressed by the ratio of the number of catheterization cases to the catheter indwelling day, i.e. the case / 1000 catheter day. Statistical analysis was carried out with SPSS11.0 software. Counting data using chi-square test, P0.05 for statistical significance. The result is 1: 1. Poor living conditions, hemoglobin 90 g / L, is a risk factor for catheter-related infections in semi-permanent dialysis, P0.05.2. Sex, age, serum albumin, serum creatinine, primary disease and catheter indwelling time were not significantly correlated with the incidence of catheter-related infection in semi-permanent dialysis patients (P 0.05). Conclusion: poor living environment, 90 g / L hemoglobin, may be a risk factor for catheter-related infection.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R459.5

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本文編號(hào)：2335037