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中国循证儿科杂志

中国循证儿科杂志 ›› 2025, Vol. 20 ›› Issue (1): 53-56.DOI: 10.3969/j.issn.1673-5501.2025.01.009

• 论著 • 上一篇    下一篇

上海市单中心儿童腹膜透析导管污染事件的横断面调查

沈霞,何浩,张慧,赵蕊,周佳,顾莺,沈茜,徐虹,周清   

  1. 国家儿童医学中心复旦大学附属儿科医院肾脏内科 上海，201102
  • 收稿日期:2023-01-06 修回日期:2025-02-20 出版日期:2025-02-25 发布日期:2025-02-25
  • 通讯作者: 周清

Catheter contamination events on peritoneal dialysis children in a single center in Shanghai: A cross-sectional survey

SHEN Xia, HE Hao, ZHANG Hui, ZHAO Rui, ZHOU Jia, GU Ying, SHEN Qian, XU Hong, ZHOU Qing   

  1. Department of Nephrology,National Children's Medical Center,Children's Hospital of Fudan University,Shanghai 201102,China
  • Received:2023-01-06 Revised:2025-02-20 Online:2025-02-25 Published:2025-02-25
  • Contact: ZHOU Qing

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摘要： 背景：接触性导管污染是慢性腹膜透析儿童发生腹膜炎并发症的常见原因之一。 目的：调查慢性腹膜透析儿童中导管污染事件的发生情况及其影响因素。 设计：横断面调查。 方法：： 纳入2010年1月至2021年3月在复旦大学附属儿科医院腹膜透析中心行慢性腹膜透析治疗并随访的患儿。收集患儿及其照护者的一般资料，从腹膜透析档案中截取导管污染事件的发生情况，以及可能的影响因素（患儿年龄、性别、透析疗程、有无兄弟姐妹，主要照护者的年龄、文化程度、工作情况、与患儿关系、首次培训考核分数，透析过程中是否更换操作者）。 主要结局指标：导管污染的影响因素。 结果：263例慢性腹膜透析患儿均采用全自动腹膜透析（APD），男128例（48.7%），开始APD时(7.9±4.2)岁，透析疗程13（5，21）个月，19例患儿（7.2%）中途更换了操作者。共发生48例次导管污染（18.3%），其中干性污染30例次、湿性污染18例次。1例湿性污染后出现腹膜透析相关腹膜炎，抗感染治疗2周后好转出院。透析疗程＞2个月的患儿中导管污染的发生率高于透析疗程≤2个月的患儿（20.5% vs 6.8%,P=0.03），更换APD操作者的患儿导管污染的发生率高于未更换者(68.4% vs 14.3%,P＜0.001)，导管污染组患儿主要照护者的首次培训考核分数低于导管未污染组［（96.3±1.1）分 vs （97.1±1.2）分，P＜0.001］。患儿照护者首次培训考核分数(OR=0.54，95%CI：0.40~0.74,P＜0.001)、透析过程中更换照护者(OR=11，95%CI：4.07~37.43，P＜0.001)是导管污染事件发生的主要影响因素。 结论：儿童腹膜透析导管污染以干性污染为主，患儿照护者首次培训考核分数以及透析过程中更换照护者是发生导管污染的主要影响因素。

关键词: 腹膜透析, 儿童, 导管污染, 护理

Abstract: Background：Contact catheter contamination is one of the common causes of peritonitis in children undergoing chronic peritoneal dialysis (PD). Objective：To investigate the status and risk factors of catheter contamination in children undergoing chronic peritoneal dialysis. Design：Cross-sectional survey. Methods：The children who received chronic peritoneal dialysis treatment and follow-up at the Peritoneal Dialysis Center of Children's Hospital of Fudan University were included between January 2010 and March 2021 in this study. General data of the children and their caregivers were collected, including information on catheter contamination events from PD records and relevant factors of children's age, gender, dialysis duration, presence of siblings, caregivers' age, education level, employment status, relationship with child, and initial training assessment score and PD operator change. Main outcome measures：Risk factors for catheter contamination. Results：A total of 263 children undergoing chronic peritoneal dialysis (CPD) were included in the study, all of whom were treated with automated peritoneal dialysis (APD). Among them, 128 (48.7%) were male, with a mean age of (7.9±4.2) years at the initiation of APD. The median dialysis duration was 13 (5, 21) months, and 19 children (7.2%) had a caregiver change during the treatment. There are 48 catheter contamination events (18.3%), including 30 cases of dry contamination and 18 cases of wet contamination. One case of wet contamination led to peritoneal dialysis-associated peritonitis, which improved after two weeks of antibiotic treatment and hospital discharge. Children with a dialysis duration of more than two months had a higher incidence of catheter contamination compared to those with a duration of ≤2 months (20.5% vs. 6.8%, P=0.03). Additionally, children who experienced a change in APD caregivers had a significantly higher incidence of catheter contamination compared to those without a caregiver change (68.4% vs. 14.3%, P<0.001). The initial training assessment scores of primary caregivers in the catheter contamination group were significantly lower than those in the non-contamination group ［(96.3±1.1) vs. (97.1±1.2), P<0.001］. The primary influencing factors for catheter contamination events were the caregiver's initial training assessment score (OR=0.54, 95%CI: 0.40-0.74, P<0.001) and a caregiver change during dialysis (OR=12.34, 95%CI: 4.07-37.43, P<0.001). Conclusion：Dry contamination is the predominant type of catheter contamination in children undergoing peritoneal dialysis. The primary influencing factors for catheter contamination were the initial training assessment score of the child's caregiver and a caregiver change during the dialysis process.

Key words: Peritoneal dialysis, Children, 导管污染