不同锁骨下静脉置管方法对危重患者导管相关血流感染发病率的影响
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李洪荣

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R181.3+2

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Effect of different subclavian vein catheterization methods on catheterrelated bloodstream infection in critically ill patients
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    摘要:

    目的探讨不同锁骨下静脉置管方法对危重患者导管相关血流感染(CRBSI)的影响。方法回顾性调查某院重症医学科2008年5月—2015年12月锁骨下静脉置管留置时间>7 d的患者。分为三组:超声引导精确置管组(A组),常规单腔不扩皮组(B组),常规双腔组(对照组)。调查内容包括:姓名、年龄、诊断、APACHEⅡ评分、置管位置、方法、是否穿刺一次成功、留置导管时间、CRBSI情况、病原菌检出情况等。 比较不同置管方法CRBSI发病率和日发病率,以及CRBSI病原学分布。结果共调查患者2 366例,其中A组789例,B组786例,对照组791例。A组发生CRBSI 13例,CRBSI发病率为1.65%,日发病率为1.09‰;B组发生CRBSI 15例,CRBSI发病率为1.91%,日发病率为1.27‰;对照组发生CRBSI 40例,CRBSI发病率为5.06%,日发病率为3.36‰;A、B组及对照组的穿刺一次成功率分别为97.47%、88.80%、87.23%。三组患者的CRBSI发病率、CRBSI日发病率、穿刺一次成功率比较,差异均有统计学意义(均P<0.01)。经两两比较,穿刺一次成功率A组高于B组、对照组,差异均有统计学意义(χ2值分别为46.25、58.50,均P<0.01);CRBSI发病率对照组高于A、B组,差异均有统计学意义(χ2值分别为12.82、18.35,均P<0.01);CRBSI日发病率对照组高于A、B组,差异均有统计学意义(χ2值分别为13.74、11.22,均P<0.01)。三组患者各检出病原菌13、15、40株,均以表皮葡萄球菌和金黄色葡萄球菌为主,对照组凝固酶阴性葡萄球菌感染比例高于A、B组。结论超声引导锁骨下静脉精确置管与常规置管方法(单腔、双腔)相比能有效提高穿刺成功率,超声引导精确置管及常规单腔不扩皮锁骨下静脉置管较常规双腔置管方法能够减少患者CRBSI的发生。

    Abstract:

    ObjectiveTo evaluate the effect of different subclavian vein catheterization methods on catheterrelated bloodstream infection(CRBSI) in critically ill patients. MethodsPatients with subclavian vein catheterization for more than 7 days in the intensive care unit of a hospital between May 2008 and December 2015 were investigated retrospectively. They were divided into three groups: ultrasoundguided catheterization group(group A), conventional single lumen subclavian vein catheterization without skin expansion group(group B), conventional  double lumen subclavian vein catheterization group(control group). The survey included name, age, diagnosis, APACHE II score, catheterization sites and methods, whether or not succeeded in single catheterization, duration of catheterization, occurrence of CRBSI, and isolation of pathogens. Incidence of CRBSI, CRBSI per 1 000 catheterdays, and distribution of pathogens causing CRBSI were compared respectively among patients with different catheterization methods. ResultsA total of 2 366 patients were surveyed (group A, n=789; group B, n=786; control group, n=791). In group A, B, and control group, 13,15, and 40 cases developed CRBSI respectively, incidence of CRBSI were 1.65%, 1.91%, and 5.06% respectively,incidence of CRBSI per 1 000 catheterdays were 1.09‰, 1.27‰, and 3.36‰ respectively, the percentage of success in single catheterization were 97.47%, 88.80%, 87.23% respectively. There were significant difference in incidence,incidence of CRBSI per 1 000 catheterdays, and percentage of success in single catheterization among three groups(all P<0.01). Pairwise comparison showed that percentage of success in single catheterization in group A was higher than group B and control group, difference were significant (χ2 =46.25, 58.50,both P<0.01);incidence of CRBSI in control group was higher than group A and B(χ2 =12.82, 18.35 respectively,both P<0.01);incidence of CRBSI per 1 000 catheterdays in control group was higher than group A and B(χ2 =13.74, 11.22 respectively, both P<0.01). 13, 15, 40 strains of pathogens were isolated from three groups, Staphylococcus epidermidis and Staphylococcus aureus were the main pathogens in three groups, the proportion of coagulase negative staphylococcus infection in control group was higher than group A and B. ConclusionCompared with conventional catheterization methods (single lumen, double lumen), ultasoundguided subclavian vein catheterization can effectively improve the success rate of puncture. Ultrasoundguided catheterization and conventional single lumen subclavian vein catheterization without skin expansion can reduce the occurrence of CRBSI compared with double lumen subclavian vein catheterization.

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王静, 李洪荣, 秦霞.不同锁骨下静脉置管方法对危重患者导管相关血流感染发病率的影响[J]. 中国感染控制杂志,2017,16(12):1152-1155. DOI:10.3969/j. issn.1671-9638.2017.12.010.
WANG Jing, LI Hongrong, QIN Xia. Effect of different subclavian vein catheterization methods on catheterrelated bloodstream infection in critically ill patients[J]. Chin J Infect Control, 2017,16(12):1152-1155. DOI:10.3969/j. issn.1671-9638.2017.12.010.

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  • 收稿日期:2016-12-12
  • 最后修改日期:2017-02-10
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  • 在线发布日期: 2017-11-30
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