终末期肾病血液透析患者感染死亡事件调查

目的 探讨终末期肾病血液透析（血透）患者感染死亡的临床特点及防治措施。 方法 回顾性调查1998年至2008年在本院血透中心登记透析并随访死亡的终末期肾病患者的资料，分析感染作为直接死因及促进因素在死亡患者中的作用。 结果 共252例死亡，其中男性162例（64.29%），女性90例（35.71%），死亡年龄为（63.48±14.77）岁，紧急透析者占59.52%。首位基础疾病为原发性肾小球疾病（27.23%），其次为糖尿病肾病（16.90%）和高血压肾病（14.55%）。17.4%患者直接死因为感染，17.4%患者为感染促进死亡。首位死因为脑血管事件，占23.6%，心血管事件占13.4%。在老年患者组（≥65岁），感染作为直接死因和促进因素者分别占18.63%和21.57%。与感染有关死亡者年龄显著高于非感染相关死亡者。因感染死亡患者及因感染促进死亡患者中存活<3个月者分别占48.15% 和38.71%，高于非感染相关死亡患者的30.34%。存活>2年者中，前两者比例分别为22.22%和32.26%，低于非感染相关死亡患者中比例（37.93%）。死亡患者最常见的感染为肺部感染（77.59%），其次为血行感染（10.34%），导管相关性感染（5.17%）。58.62%感染有关死亡者病原检出阳性，以革兰阴性杆菌居多（38.24%），50%检出者合并真菌感染。 结论 感染是终末期肾病血透患者重要直接死因及死亡促进因素，且是老年患者和透析开始3个月内的主要死因。引起血透患者死亡的感染以肺部感染最常见。致病菌以革兰阴性杆菌多见，且半数患者合并真菌感染。应重视血透患者感染的防治，尤其在老年患者和透析初期。

Investigation of death events caused by infection in end-stage renal disease patients undergoing hemodialysis

Objective To explore the clinical characteristics and prevention management of death events caused by infections in end-stage renal disease (ESRD)patients undergoing hemodialysis. Methods Clinical data of ESRD patients undergoing hemodialysis in Nephrology Department of Zhongshan Hospital from 1998 to 2008 were retrospectively studied.Death causes,primary diseases,complications,infections,and survival time were analyzed. Results A total of 252 patients died including 162 males(64.29%)and 90 females(35.71%).Average death age was (63.48±14.77)years.In death events,emergency dialysis accounted for 59.52%,and primary glomerular disease was the major primary diseases(27.23%),then diabetic nephropathy(16.90%)and hypertensive nephrosclerosis (14.55%).34.8%death was caused by infections or promoted by infections,secondly by cerebrovascular events(23.6%).The elderly accounted for the majority of infection-associated deaths.48.15%and 38.71%patients with deaths caused or promoted by infections respectively had shorter dialysis duration(<3 months),whose percentage was much higher than those with non-infection-associated deaths (30.34%).Primary infection was still pulmonary infection(77.59%),then blood infection(10.34%)and catheter-associated infection(5.17%).58.62%infection-associated deaths had positive microbiologic test results,and gram negative bacillus accounted for 38.24%.50% of patients with positive test was complicated with fungal infection. Conclusions Infection is a main cause and a critical promotion to death in ESRD hemodialysis patients,besides it is the main cause of death in the elderly (>75 years)and hemodialysis duration within 3 months,which may result in shorter survival.Pulmonary infection and gram negative bacillus combined with fungal infection should be considered in the treatment.Prophylaxis of nosocomial infection and pulmonary infection in hemodialysis patients should be more emphasized.