摘要
目的研究尿毒症血液透析患者的营养状况及其罹患肺部感染的危险因素,为临床提供参考依据。方法回顾性分析2017年1月至2019年1月在西安市高新医院进行尿毒症血液透析134例患者的临床资料,按照是否并发肺部感染将患者分为感染组42例和未感染组92例。比较两组患者的营养状况及血清白蛋白(Alb)、胆固醇(Ch)、血红蛋白(Hb)、前白蛋白(PA)、肌酐(Cr)、透析治疗效率标准(KT/V)与尿素下降率(URR)、年龄、病程、C-反应蛋白(CRP)、糖尿病患病率和空腹血糖(GLU)水平,对感染组患者的病原菌分布状况进行分析,选择多因素Logistic回归分析对感染组患者发生肺部感染的危险因素进行分析。结果感染组患者的总营养不良发生率为78.57%,明显高于未感染组的58.69%,差异有统计学意义(P<0.05);感染组患者的Alb、Ch、Hb、PA水平分别为(18.53±6.84)g/L、(4.07±0.61)mmol/L、(64.73±16.26)g/L、(33.73±6.38)g/L,明显低于未感染组的(38.83±7.02)g/L、(4.18±0.53)mmol/L、(82.27±14.19)g/L、(40.41±8.47)g/L,Cr水平为(895.65±183.95)μmol/L,明显高于未感染组的(793.26±160.37)μmol/L,差异均有统计学意义(P<0.05);感染组患者送检共42份标本,其中细菌培养阳性者共20份,占47.62%;病原菌感染中最常见的是革兰阴性菌,依次是肺炎克雷伯菌、铜绿假单胞菌与流感嗜血菌,占比分别为30.00%、20.00%、10.00%;感染组患者的KT/V与URR分别为(1.20±0.11)、(59.93±3.48)%,明显低于未感染组的(1.36±0.17)、(64.84±4.43)%,差异均有统计学意义(P<0.05);感染组患者的年龄、病程、CRP、GLU水平明显高于未感染组,且感染组患者糖尿病患病率19.05%,明显高于未感染组的6.52%,差异均有统计学意义(P<0.05);经多因素Logistic回归分析结果显示,年龄、病程、CRP水平、糖尿病患病率、GLU水平与透析充分性是肺部感染患者的危险因素(P<0.05)。结论尿毒症血液透析患者发生营养不良的概�
Objective To study the nutritional status of patients with uremia undergoing hemodialysis and to analyze the risk factors for pulmonary infection,in order to provide a reference for clinical practice.Methods A retrospective analysis was performed on 134 patients with uremia undergoing hemodialysis from January 2017 to January2019 in Xi’an Gaoxin Hospital.The patients were divided into infected group(n=42)and uninfected group(n=92)according to whether they had complicated pulmonary infection.Comparison was performed between the two groups in nutritional status,serum albumin(Alb),cholesterol(Ch),hemoglobin(Hb),prealbumin(PA),creatinine(Cr),dialysis treatment efficiency standard(KT/V),urea reduction rate(URR),age,course of disease,C-reactive protein(CRP),prevalence of diabetes,and fasting blood glucose(GLU)levels.The distribution of pathogenic bacteria in patients in the infected group was analyzed,and multi-factor Logistic regression analysis was used to analyze the risk factors for pulmonary infection.Results The incidence of malnutrition in the infected group(78.57%)was significantly higher than that in the uninfected group(58.69%),and the difference were statistically significant(P<0.05).The levels of Alb,Ch,Hb,and PA in the infected group were(18.53±6.84)g/L,(4.07±0.61)mmol/L,(64.73±16.26)g/L,(33.73±6.38)g/L,significantly lower than(38.83±7.02)g/L,(4.18±0.53)mmol/L,(82.27±14.19)g/L,(40.41±8.47)g/L in the uninfected group(P<0.05);Cr level was(895.65±183.95)μmol/L in the infected group,significantly higher than(793.26±160.37)μmol/L in the uninfected group(P<0.05).Among the 42 specimens detected in the infected group,20 were positive for bacterial culture,accounting for 47.62%.The most common pathogens were Gram-negative bacteria,with Klebsiella pneumoniae accounting for 30.00%,Pseudomonas aeruginosa for 20.00%,and Haemophilus influenza for 10.00%.The KT/V and URR were 1.20±0.11,(59.93±3.48)%in the infected group,significantly lower 1.36±0.17,(64.84±4.43)%in the uninfected group(P<0.05).The age,c
作者
刘佩
吴改红
张沛
王维
LIU Pei;WU Gai-hong;ZHANG Pei;WANG Wei(Department of Nephrology,Xi'an Gaoxin Hospital,Xi'an 710075,Shaanxi,CHINA)
出处
《海南医学》
CAS
2020年第9期1121-1124,共4页
Hainan Medical Journal
