【摘要】目的探讨水胶体敷料与3M 敷料对腹膜透析(peritoneal dialysis,PD)患者隧道管口感染的预防效果，并分析影响导管出口处感染的危险因素。方法选取2018 年6 月～2020 年12 月于承德市中心医院肾内科收治的154 例PD 患者，依据入组患者开始透析时隧道管口敷料类型分为水胶体敷料组(n=86)和3M 敷料组(n=68)。比较2 组患者出院前的感染控制情况以及治愈率，统计分析治愈时间、换药次数以及不良反应情况。根据患者是否存在出口处感染分为感染组、非感染组，采用Logistic 回归分析导管出口处感染的危险因素。结果水胶体敷料组感染率低于3M 敷料组(4.65%比14.71%)，差异有统计学意义(U=2.005，P=0.045)。非感染组的管道固定不良、不依从出口护理流程、出口机械性压迫占比低于感染组(χ2=6.755、4.200、5.468，P=0.009、0.040、0.019)。Logistic 回归分析显示，管道固定不良(OR=1.793；95%CI:1.060～3.032，P=0.029)、敷料类型(OR=1.592；95% CI:1.065～2.379,P=0.023)均是
影响导管出口处感染的危险因素。结论水胶体敷料可降低PD 患者隧道管口感染发生率，利于出口处愈合，且安全性较好。护理过程中需保证管道固定位置，指导PD 患者依从出口护理流程以及避免出口机械性压迫。

【Abstract】Objective To explore the preventive effect of hydrocolloid dressing and 3M dressing on tunnel orifice infection in peritoneal dialysis (PD) patients, and to analyze the risk factors for the catheter orifice infection. Methods A total of 154 PD patients admitted to the Department of Nephrology of Chengde Central Hospital from June 2018 to December 2020 were recruited and divided into hydrocolloid dressing group (n=86) and 3M dressing group (n=68) according to the type of tunnel orifice dressing at the time the dialysis started. The infection control rate and cure rate before discharge from the hospital were compared between the two groups. The cure time, the number of dressing changes and adverse reactions were analyzed. Patients were also divided into infection group and non-infection group according to the situation of tunnel orifice infection. Logistic regression was used to analyze the risk factors for tunnel orifice infection. Results The infection rate was statistically lower in the hydrocolloid dressing group than in the 3M dressing group (4.65% vs. 14.71%; U=2.005, P=0.045). The proportions of poor tube fixation, incompliance with orifice care procedures and orifice mechanical compression were significantly lower in the non-infection group than in the infection group (χ2=6.755, 4.200 and 5.468 respectively; P=0.009, 0.040 and 0.019 respectively). Logistic regression
showed that poor fixation of the tube (OR=1.793, 95% CI:1.060~3.032, P=0.029) and dressing type (OR=1.592, 95% CI: 1.065~ 2.379, P=0.023) were the risk factors for tunnel orifice infection. Conclusion The hydrocolloid dressing reduced the incidence of tunnel orifice infection in PD patients and facilitated healing of the infection with safety. Careful should be paid to fix the PD tube, to guide the patients following the orifice nursing processes, and to avoid mechanical pressure on the orifice during nursing PD patients.