基于优化的信息化监测软件开展血液透析事件监测

Monitoring on hemodialysis events based on optimized information monitoring software

摘要:

目的 对门诊血液透析患者进行血液透析事件（DE）监测，获得门诊血液透析患者DE发生率，验证通过优化的信息化监测软件开展DE监测的有效性。 方法 基于优化的信息化监测软件，选取2019年8月—2020年7月每月前2个工作日内在徐州医科大学附属医院门诊进行维持性血液透析治疗的患者，采用前瞻性调查方法，调查患者抗菌药物使用、血管通路感染及血培养结果阳性情况，监测DE发生情况。 结果 共监测5 393例门诊血液透析患者，发生DE 206例，发生率为3.82/100患者·月。使用优化后的监测软件对DE监测发现，按照不同DE事件类型比较，软件更新后血管通路部位DE发生率升高（0.70/100患者·月VS 0.10/100患者·月），差异具有统计学意义（P < 0.001）；按照不同血管通路类型比较，软件更新后其他血管通路类型DE发生率下降（4.19/100患者·月VS 4.60/100患者·月），而隧道式和非隧道式导管DE发生率升高（11.79/100患者·月VS 2.64/100患者·月，13.20/100患者·月VS 7.33/100患者·月），差异均有统计学意义（均P < 0.05）。2019年8月患者DE发生率最高（9.51/100患者·月），监测期间DE发生率呈下降趋势，至2020年7月，下降至1.05/100患者·月。 结论 DE发生率高，通过优化后的信息化监测软件进行监测切实可行，可有效获得感染相关基线数据，发现感染防控薄弱点，有效降低感染发生率。

Abstract:

Objective To monitor hemodialysis events (DE) in hemodialysis outpatients, obtain the incidence of DE, and verify the effectiveness of monitoring on DE through optimized information monitoring software. Methods Based on the optimized information monitoring software, patients who underwent maintenance hemodialysis in outpatient department of the Affiliated Hospital of Xuzhou Medical University in the first two working days of each month from August 2019 to July 2020 were selected, prospective survey method was adopted to investigate antimicrobial use, vascular access infection and positive blood culture results of patients, the occurrence of DE was monitored. Results A total of 5 393 hemodialysis outpatients were monitored, there were 206 cases (3.82/100 patients·month) of DE. DE was monitored by optimized monitoring software, it was found that after software was updated, incidence of DE at vascular access sites increased according to the comparison of different types of DE (0.70/100 patients·month vs 0.10/100 patients·month), difference was significant (P < 0.001); according to the comparison of different vascular access types, after software was updated, incidence of DE in other vascular access types decreased(4.19/100 patients·month vs 4.60/100 patients·month), while incidence of DE in tunneled and non-tunneled catheters increased significantly (11.79/100 patients·month vs 2.64/100 patients·month, 13.20/100 patients·month vs 7.33/100 patients·month), difference were both significant (both P < 0.05). In August 2019, incidence of DE in patients was the highest (9.51/100 patients·month), during the monitoring period, incidence of DE showed a downward trend and decreased to 1.05/100 patients·month by July 2020. Conclusion Incidence of DE is high, monitoring through optimized information monitoring software is feasible, which can effectively obtain infection-related baseline data, find weak points in infection prevention and control, and effectively reduce the incidence of infection.