陈漪,严玉茹.单中心糖尿病腹膜透析患者腹膜炎的临床分析及护理对策[J].上海护理,2020,20(7):
单中心糖尿病腹膜透析患者腹膜炎的临床分析及护理对策
Clinical features and nursing strategies of peritonitis in diabetic peritoneal dialysis patients
DOI:
中文关键词:  腹膜透析  糖尿病  腹膜炎  临床预后  护理对策;
英文关键词:Peritoneal dialysis  Diabetes mellitus  peritonitis  Clinical prognosis  Nursing strategies  
基金项目:上海交通大学医学院科技(Jyh1704)
作者单位E-mail
陈漪 上海交通大学医学院附属仁济医院肾脏内科,200127 just-yi@163.com 
严玉茹* 上海交通大学医学院附属仁济医院肾脏内科,200127 yanyuru@renji.com 
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中文摘要:
      目的 比较糖尿病腹膜透析患者与非糖尿病腹膜透析患者腹膜炎发生的临床特征及预后情况,针对其临床特征提出相应的护理对策。 方法 本研究为单中心、回顾性队列研究。分析上海某三级甲等医院腹膜透析中心2010年6月-2017年6月行腹膜透析置管并行持续不卧床腹膜透析治疗的患者临床资料,其中糖尿病肾病腹膜透析患者及合并糖尿病的非糖尿病肾病腹膜透析患者总计67例,30例至少发生过1次腹膜炎,占44.8%;非糖尿病腹膜透析患者共216例,其中68例至少发生过1次腹膜炎,占31.4%,分析此30例糖尿病腹膜透析患者及68例非糖尿病腹膜透析患者在首次发生腹膜炎时的临床特征及其预后情况。结果 基本资料方面,与非糖尿病患者相比,糖尿病患者平均年龄较大,有统计学差异(P<0.05);两组患者的透析方式(本人、家人或保姆操作)有统计学差异(P<0.05);实验室检查方面,两组患者的血红蛋白、血清白蛋白、血清C反应蛋白、三酰甘油、血磷、钙磷乘积、均有统计学差异(P<0.05);预后方面,糖尿病腹膜透析患者较非糖尿病腹膜透析患者有着更早发生腹膜炎的趋势,有统计学差异(P<0.05);合并症方面,糖尿病腹膜透析患者的心血管疾病发生率高于非糖尿病患者,有统计学差异(P<0.05),而脑血管疾病并无统计学差异(P>0.05);糖尿病腹膜透析患者的死亡率及因拔管导致退出腹膜透析情况均高于非糖尿病腹膜透析患者,存在统计学差异(P<0.05)。结论 糖尿病腹膜透析患者的预后情况比非糖尿病腹膜透析患者差,更易发生感染及营养不良,因此护理人员需对此类患者加强腹膜透析操作的指导及教育。
英文摘要:
      Objective: To compare the clinical characteristics and prognosis of peritonitis in diabetic peritoneal dialysis patients and non-diabetic peritoneal dialysis patients. Methods: This study was a single-institution、retrospective cohort study. The clinical data of peritoneal dialysis patients from June 2010 to June 2017 were retrospectively analyzed. Total of 67 patients with non-diabetic nephropathy peritoneal dialysis patients, 30 cases had peritonitis at least 1 time, accounting for 44.8%; non-diabetic peritoneal dialysis patients of 216 cases, of which 68 cases had peritonitis at least 1 time, accounting for 31.4%. The clinical characteristics and prognosis of the first occurrence of peritonitis in 30 patients with diabetes peritoneal dialysis and 68 patients with non-diabetic peritoneal dialysis were analyzed. Results: In terms of basic data, the average age of diabetic peritoneal dialysis patients was significantly higher than that of non-diabetic patients (P<0.05); there was a significant difference between the two groups of patients in the mode of peritoneal dialysis (patients、family members or nanny)(P<0.05); In laboratory examinations, the hemoglobin, serum albumin, hs-CRP, triglycerides, serum phosphorus, calcium-phosphorus product, and iPTH were statistically different between the two groups (P<0.05). In the prognosis, the non-peritonitis survival rate of diabetic peritoneal dialysis patients was significantly lower than that of non-peritoneal dialysis patients. Diabetes patients were statistically significant (P<0.05), point out that the former has a tendency of earlier peritonitis; In terms of complications, diabetic peritoneal dialysis patients have a higher incidence of cardiovascular disease than non-diabetic patients, there is a statistical difference between them(P<0.05). the mortality rate of diabetic peritoneal dialysis patients and the status of withdrawal peritoneal dialysis were higher than those in non-diabetic peritoneal dialysis patients, there was a statistical difference between them(P<0.05). Conclution:Diabetic peritoneal dialysis patients are more prone to infection and malnutrition, so nurses need to strengthen the guidance and education for such patients.Strengthen diet education 、control blood sugar、strengthen the care of catheter is the key to preventing the diabetic peritoneal dialysis patients.
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