CAJ | 학술논문

目的：探讨慢性肾功能衰竭患者行血液透析发生医院感染的病原菌分布及其临床特点，为减少血液透析室医院感染提供依据。方法回顾性分析2011年1月－2014年12月在医院进行血液透析的850例慢性肾功能衰竭患者的临床资料，按是否发生医院感染进行分组，感染组32例、非感染组818例，对感染患者的送检标本进行病原菌培养，对感染病原菌分布及患者临床特点、医院感染相关因素进行分析；采用SPSS18．0软件进行统计分析。结果850例慢性肾功能衰竭血液透析患者中发生医院感染32例，感染率为3．76％；标本来源以痰液为主，占55．00％，其次为血液、尿液，分别占30．32％、10．97％；共分离出病原菌620例，其中革兰阳性菌分离出209株占33．71％，革兰阴性菌393株占63．39％，真菌18株占2．90％；感染组患者血红蛋白、血清白蛋白、血清球蛋白水平与非感染组比较，均显著性降低，差异均有统计学意义（P＜0．05）；感染组患者CRP水平显著性高于非感染组（P＜0．05）；年龄、贫血、透析龄、置管方式、心功能不全、低蛋白血症、糖尿病肾病等因素是慢性肾功能衰竭血液透析患者医院感染的危险因素（P＜0．05）。结论慢性肾功能衰竭血液透析患者医院感染病原菌种类较多，贫血、低蛋白血症、糖尿病肾病患者容易发生医院感染，临床应根据感染危险因素进行针对性干预。
목적：탐토만성신공능쇠갈환자행혈액투석발생의원감염적병원균분포급기림상특점，위감소혈액투석실의원감염제공의거。방법회고성분석2011년1월－2014년12월재의원진행혈액투석적850례만성신공능쇠갈환자적림상자료，안시부발생의원감염진행분조，감염조32례、비감염조818례，대감염환자적송검표본진행병원균배양，대감염병원균분포급환자림상특점、의원감염상관인소진행분석；채용SPSS18．0연건진행통계분석。결과850례만성신공능쇠갈혈액투석환자중발생의원감염32례，감염솔위3．76％；표본래원이담액위주，점55．00％，기차위혈액、뇨액，분별점30．32％、10．97％；공분리출병원균620례，기중혁란양성균분리출209주점33．71％，혁란음성균393주점63．39％，진균18주점2．90％；감염조환자혈홍단백、혈청백단백、혈청구단백수평여비감염조비교，균현저성강저，차이균유통계학의의（P＜0．05）；감염조환자CRP수평현저성고우비감염조（P＜0．05）；년령、빈혈、투석령、치관방식、심공능불전、저단백혈증、당뇨병신병등인소시만성신공능쇠갈혈액투석환자의원감염적위험인소（P＜0．05）。결론만성신공능쇠갈혈액투석환자의원감염병원균충류교다，빈혈、저단백혈증、당뇨병신병환자용역발생의원감염，림상응근거감염위험인소진행침대성간예。
OBJECTIVE To explore the distribution of the pathogens causing nosocomial infections in the chronic re‐nal failure patients undergoing hemodialysis and analyze the clinical characteristics so as to reduce the incidence of nosocomial infections in the hemodialysis room .METHODS A total of 850 patients with chronic renal failure who underwent the hemodialysis from Jan 2011 to Dec 2014 were enrolled in the study ,then the clinical data of the pa‐tients were retrospectively analyzed ,the participants were divided into the infection group with 32 cases and the non‐infection group with 818 cases according to the status of nosocomial infections ,the submitted specimens from the patients with infections were cultured for pathogens ,the distribution of the pathogens ,clinical characteristics of the patients ,and related factors for nosocomial infections were observed ,and the statistical analysis was per‐formed with the use of SPSS 18 .0 software .RESULTS The nosocomial infections occurred in 32 of 850 chronic re‐nal failure patients undergoing hemodialysis ,w ith the infection rate of 3 .76% .T he sputum (55 .00% ) w as the major specimen sources ,followed by the blood (30 .32% ) and urine (10 .97% ) .Totally 620 strains of patho‐gens have been isolated ,including 209 (33 .71% ) strains of gram‐positive bacteria ,393 (63 .39% ) strains of gram‐negative bacteria ,and 18 (2 .90% ) strains of fungi .The levels of hemoglobin ,serum albumin ,and serum globulin of the infection group were significantly lower than those of the non‐infection group(P< 0 .05);the level of CRP of the infection group was significantly higher than that of the non‐infection group (P< 0 .05) .The risk factors for the nosocomial infections in the chronic renal failure patients undergoing hemodialysis included the age ,anemia ,dialysis age ,ways of catheterization ,cardiac insufficiency ,hypoproteinemia ,and diabetic nephropathy (P< 0 .05) .CONCLUSION The pathogens causing the nosocomial infections in the chronic renal failure patients undergoing hemodialysis are diversified;the anemia ,hypoproteinemia ,and diabetic nephropathy are the risk fac‐tors for the nosocomial infections .It is necessary for the hospital to take targeted interventions aiming at the risk factors .