摘要
目的 分析心脏重症患者漂浮导管相关性血流感染（CRBSI）的危险因素.方法 连续收集2013年1月—2014年12月入住温州医科大学附属第一医院心脏重症监护室的768例行漂浮导管检查心脏重症患者,患者出现感染征兆时、疑是导管相关性感染或置管时间超过7天拔除导管时均进行导管血培养和尖端5 cm细菌培养.结果 768例患者目标监测3050个导管日,发生导管血流感染23例,CRBSI的千导管日感染发生率为7.5‰,感染率约为3.0%.培养结果 前5位的致病菌是金黄色葡萄球菌、溶血性葡萄球菌、表皮葡萄球菌、白色念珠菌、肺炎克氏菌.患者性别、年龄、是否有糖尿病以及置管期间合用抗生素与导管相关性感染无相关性（P〉0.05）,患者置管前全身皮肤是否充分清洁、导管留置时间长短与导管相关性感染具有相关性（P〈0.05）.多因素Logistic回归分析表明置管前全身皮肤充分清洁是导管相关感染的独立保护性因素,长时间置管、置管期间合用抗生素治疗是导管相关感染的独立危险因素（P〈0.05）.结论 心脏重症患者行漂浮导管监测发生导管相关性血流感染与导管留置时间的长短有关;置管前全身皮肤清洁可有效减低感染的发生率,置管期间使用抗生素不能降低导管相关感染的发生率.
Objective To analyze risk factors of Swan-Ganz catheter-related bloodstream infections （ CRBSI） in patients with severe heart disease in Cardiac Care Unit （ CCU） . Methods A total of 768 patients undergoing indwelling Swan-Ganz catheterization in CCU between January 2013 to December 2014 were enrolled in this study. Bacterial culture of blood in catheter and catheter tip that 5 cm distance from distal end were performed if the patients were suspected of intravascular catheter-related infections or the catheter was removed from the patients for more than 7 days. Results During 3050 catheter days, 23 of 768 patients were diagnosed of CRBSI（7. 5 ‰）, and the infection rate was about 3%. The top 5 pathogenic bacteria were staphylococcus aureus, staphylococcus haemolyticus, staphylococcus epidermidis, albicans saccharomyces and klebsiella pneumoniae. The patient′s gender, ages, with diabetes or not, and usage of antibiotic during catheterization had no correlation with catheter related infection （P 〉0. 05）, but the skin of whole body clean or not before catheterization, the length of catheterization had correlation with catheter related infection （ P 〈 0. 05 ）. Multivariate logistic regression analysis showed that the whole bode skin clean before catheterization was the protective factor for CRBSI, and long catheter indwelling time and combined antibiotic treatment during catheterization were the risk factors for CRBSI （P〈0. 05）. Conclusions The incidence of CRBSI in patients with severe heart disease is related to the catheter indwelling time, and skin clean before indwelling which are able to effectively reduce the incidence of CRBSI. Antibiotic treatment during catheterization is not beneficial for decreasing the incidence of CRBSI.
出处
《中华现代护理杂志》
2016年第9期1298-1301,共4页
Chinese Journal of Modern Nursing
关键词
危险因素
心脏危重患者
漂浮导管
相关性血流感染
Risk factors
Severe heart disease patient
Swan-Ganz catheter
Related bloodstream infection
