Renal Division, Department of Medicine, Peking University First Hospital, Beijing, PR China.
Perit Dial Int. 2012 Jan-Feb;32(1):60-6. doi: 10.3747/pdi.2010.00208. Epub 2011 Jun 30.
We explored the relationship between the experience level of nurses and the peritonitis risk in peritoneal dialysis (PD) patients.
Our observational cohort study followed 305 incident PD patients until a first episode of peritonitis, death, or censoring. Patients were divided into 3 groups according to the work experience in general medicine of their nurses-that is, least experience (<10 years), moderate experience (10 to <15 years), and advanced experience (≥ 15 years). Demographic characteristics, baseline biochemistry, and residual renal function were also recorded. Multivariate Cox regression was used to analyze the association of risks for all-cause and gram-positive peritonitis with patient training provided by nurses at different experience levels.
Of the 305 patients, 91 were trained at the initiation of PD by nurses with advanced experience, 100 by nurses with moderate experience, and 114 by nurses with the least experience. Demographic and clinical variables did not vary significantly between the groups. During 13 582 patient-months of follow-up, 129 first episodes of peritonitis were observed, with 48 episodes being attributed to gram-positive organisms. Kaplan-Meier analysis showed that training by nurses with advanced experience predicted the longest period free of first-episode gram-positive peritonitis. After adjustment for some recognized confounders, the advanced experience group was still associated with the lowest risk for first-episode gram-positive peritonitis. The level of nursing experience was not significantly correlated with all-cause peritonitis risk.
The experience in general medicine of nurses might help to lower the risk of gram-positive peritonitis among PD patients. These data are the first to indicate that nursing experience in areas other than PD practice can be vital in the training of PD patients.
我们探讨了护士工作经验与腹膜透析（PD）患者腹膜炎风险之间的关系。
我们的观察性队列研究随访了 305 例新发 PD 患者，直至首次发生腹膜炎、死亡或失访。根据护士在普通医学方面的工作经验，将患者分为 3 组，即经验最少组（<10 年）、经验中等组（10-<15 年）和经验丰富组（≥15 年）。记录患者的人口统计学特征、基线生化指标和残余肾功能。采用多变量 Cox 回归分析不同经验水平护士提供的患者培训与全因和革兰阳性菌腹膜炎风险的关系。
在 305 例患者中，有 91 例在开始 PD 时由经验丰富的护士进行培训，100 例由经验中等的护士进行培训，114 例由经验最少的护士进行培训。组间人口统计学和临床变量无显著差异。在 13582 个患者月的随访期间，观察到 129 例首次腹膜炎发作，其中 48 例归因于革兰阳性菌。Kaplan-Meier 分析显示，由经验丰富的护士进行培训可预测最长的无首次革兰阳性菌腹膜炎期。在调整一些公认的混杂因素后，经验丰富组发生首次革兰阳性菌腹膜炎的风险仍然最低。护士的工作经验水平与全因腹膜炎风险无显著相关性。
护士的普通医学经验可能有助于降低 PD 患者革兰阳性菌腹膜炎的风险。这些数据首次表明，PD 实践以外领域的护理经验对于 PD 患者的培训至关重要。
