摘要
目的:分析危重症患者中心静脉置管后感染的相关因素及预防措施。方法:对重症监护病房363例次患者锁骨下或颈内静脉中心静脉置管后进行临床观察,分析危重症患者导管相关血行感染(CABI)的高危因素与预防措施。结果:中心静脉置管总感染计65例次,千日感染率18.5‰,例次感染率17.9%。CABI患者多发生于高龄70岁以上、男性、留置时间超过2周及APACHEⅡ评分较高患者;而营养状况、多脏器功能不全及糖尿病对CABI发生率无显著影响。多因素分析提示男性、留置时间超过2周与CABI发生的风险相关。感染菌种的菌群分布显示:革兰阳性球菌占53.6%,依次主要为表皮葡萄球菌、金黄色葡萄球菌、溶血葡萄球菌与屎肠球菌;革兰阴性杆菌占37.5%,依次主要为鲍曼不动杆菌、铜绿假单胞菌与肺炎克雷伯菌;真菌占7.1%,主要为克柔念珠菌。结论:重症患者中心静脉置管后CABI发生率较高,感染菌种以革兰阳性球菌为主,男性、导管留置时间超过2周的患者,CABI发生的风险增加,而营养状况、MODS与糖尿病对CABI的发生无显著影响。
Objective：To analyze risk factors of central venous catheter which is related to infection and to present prevention strategies in critical patients. Methods： This clinical research was conducted on 363 cases of critical patients with central venous catheters via subclavian and jugular veins, to analyze risk factors of central venous catheter related blood stream infection and to present rational prevention strategies. Results： A total of 65 cases of CABI occurred after cental venous catheterization, with a 1 000-day infection rate 18.5‰, and case infection rate of 17.9%. CABI mostly occurred in senile patients（especially over 70 s）,who are male,catheter time over 2weeks, or with high APACHE II values, however, nutrition status, MODS and diabetes did not play a critical role on CABI occurrence. Besides, multiple factor analysis reviewing male and catheter time over 2 weeks were closely related with CABI occurrence. Pathogen distribution revealed dominance of gram positive coccus（53.6%）, which in proper sequence were staphylococcus epidermidis, aureus, haemolyticus and enterococcus faecium; second predominant pathogens were gram negative bacillus（37.5%）, which in proper sequence were acinetobacter baumannii, pseudomonas aeruginosa and klebsiella pneumoniae; Fungi contributed 7.1% of CABI pathogen, which was mainly candida krusei. Conclusion： In this research, senile critical patients had higher occurrence of CABI, and the main strain of pathogen was gram positive coccus. Risk analysis pointed out that thoese paitents with old age, especially over 70 s, male gender, and with catheter time over 2 weeks and higher APACHE Ⅱ scores suffer high risk of CABI.Meantime, this research did not present remarkable connection between CABI and nutrition status, MODS, and diabetes.
出处
《南京医科大学学报（自然科学版）》
CAS
CSCD
北大核心
2014年第10期1400-1403,共4页
Journal of Nanjing Medical University(Natural Sciences)
基金
国家自然科学基金青年项目(81200196)
关键词
中心静脉导管
血行感染
危险因素
central venous catheter
blood stream infection
risk factor
