摘要
目的分析慢性肾功能衰竭(CRF)血液透析患者发生导管相关性血流感染(CRBSI)的危险因素,并构建风险预测模型。方法本研究为横断面调查。采用方便抽样法,选取2018年5月—2021年5月在中国医学科学院北京协和医院国际医疗部进行血液透析的90例CRF患者为研究对象,统计患者性别、年龄、置管部位、导管类型、导管留置时间、导管护理次数、封管法、是否严格执行手卫生、是否合并糖尿病、血红蛋白、血清白蛋白、透析时间、免疫抑制剂等资料。采用单因素分析、多因素Logistic回归分析CRF患者发生CRBSI的影响因素,并构建预测模型。采用Hosmer-Lemeshow(H-L)检验以及受试者工作特征曲线下面积(AUC)验证模型的拟合效果和区分度。结果90例CRF血液透析患者中,16例患者发生了CRBSI,发生率为17.78%(16/90)。单因素分析结果显示,年龄、置管部位、导管类型、导管留置时间、导管护理次数、是否严格执行手卫生、是否合并糖尿病、血红蛋白、血清白蛋白是CRF患者发生CRBSI的影响因素(P<0.05)。多因素Logistic回归分析结果显示,股静脉、临时导管、导管留置时间>2周、未严格执行手卫生、合并糖尿病、血清白蛋白<30 g/L是CRF血液透析患者发生CRBSI的独立危险因素(P<0.05)。H-L检验结果显示该模型拟合优度好(χ^(2)=7.978,P=0.436);受试者工作特征曲线分析结果显示该模型的AUC为0.889,最佳截断值为0.732,灵敏度为81.30%,特异性为91.90%。结论CRF血液透析患者发生CRBSI的危险因素有很多。预警模型的构建有利于对CRBSI的发生进行早期风险评估,并制订应对方案,以降低CRBSI的发生率。
Objective To analyze the influencing factors of catheter-related bloodstream infection(CRBSI)in chronic renal failure(CRF)hemodialysis patients and to construct a risk prediction model.Methods Using the convenient sampling method,a total of 90 CRF patients who underwent hemodialysis in International Medical Department of Peking Union Medical College Hospital,Chinese Academy of Medical Sciences from May 2018 to May 2021 were selected as the research objects.The gender,age,catheter placement site,catheter type,catheter retention time,catheter care times,tube sealing method,strict hand hygiene,combination with diabetes,hemoglobin,serum albumin,dialysis time,immunosuppressant and other data of the patients were analyzed.Univariate analysis and multivariate Logistic regression were used to analyze the influencing factors of CRBSI in CRF patients and a prediction model was established.Hosmer-Lemeshow(H-L)test and area under the receiver operating characteristic curve(AUC)were used to verify the fitting effect and discrimination of the model.Results Among the 90 CRF hemodialysis patients,16 patients developed CRBSI,with an incidence rate of 17.78%(16/90).The results of univariate analysis showed that age,catheter placement site,catheter type,catheter retention time,catheter nursing times,strict implementation of hand hygiene,combination with diabetes mellitus,hemoglobin,and serum albumin were the influencing factors of CRBSI in CRF patients(P<0.05).Multivariate Logistic regression analysis showed that femoral vein,temporary catheter,catheter retention time greater than 2 weeks,not strictly implementing hand hygiene,complicated with diabetes and serum albumin less than 30 g/L were independent risk factors for CRBSI in CRF hemodialysis patients(P<0.05).The H-L test results showed that the model had good goodness of fit(χ^(2)=7.978,P=0.436).The receiver operating characteristic curve analysis showed that the AUC of the model was 0.889,the best cut-off value was 0.732,the sensitivity was 81.30%and the specificity was 91.90%.Conclusions There are many risk factors for CRBSI in RF hemodialysis patients.The establishment of the early warning model is conducive to the early risk assessment of CRBSI occurrence and the formulation of countermeasures to reduce the actual incidence of CRBSI.
作者
王姗
张志媛
姚佳
赵琳
张雨辰
马燕茹
Wang Shan;Zhang Zhiyuan;Yao Jia;Zhao Lin;Zhang Yuchen;Ma Yanru(International Medical Department,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中华现代护理杂志》
2022年第23期3123-3127,共5页
Chinese Journal of Modern Nursing
关键词
透析
血液透析
慢性肾功能衰竭
导管相关性血流感染
预测模型
Dialysis
Hemodialysis
Chronic renal failure
Catheter-related bloodstream infection
Prediction model
