心血管患者外周静脉留置针留置部位与细菌定植的研究

Indwelling position and bacterial colonization of peripheral venous indwelling needles in patients with cardiovascular diseases

目的:了解心血管病患者留置针相关感染的菌群特点,并从细菌学的角度探讨心血管病患者外周静脉留置针的最佳留置部位。方法:本实验随机抽取2009年11月至2010年7月中南大学湘雅医院心血管内科收治的240例住院患者,根据留置针留置部位和留置时间将患者分为三组,即手背组、前臂组、脚组,每组又分四个时间段(T1:48 h≤t﹤72 h,T2:72 h≤t≤96 h,T3:96 h﹤t≤120 h,T4:120 h﹤t≤168 h),每组每个时间段20例患者,分别对患者穿刺部位的皮肤(皮肤消毒后、拔针时和留置针导管采样后)进行细菌培养与鉴定。结果:1)皮肤消毒后,穿刺部位皮肤样本的细菌培养均为无菌生长;2)三组患者拔针时穿刺部位皮肤样本的细菌培养中,41例有菌生长;三组患者T1和T2均未检出细菌,T3和T4两个时间段三组患者穿刺部位皮肤细菌培养阳性率比较差异有统计学意义(P<0.05);3)三组患者拔针时留置针导管样本细菌培养,10例有菌生长;手背组、前臂组患者T1,T2,T3,T4四个时间段均未检出细菌;脚组患者T1和T2未检出细菌,T3检出4例、T4检出6例,三组患者拔针时留置针导管细菌培养阳性率比较差异有统计学意义(P<0.05)。结论:心内科患者留置针的最佳留置部位是前臂。

Objective: To study the characteristics of infections associated with peripheral venous indwelling needles and to explore the best indwelling position in patients with cardiovascular diseases from the perspective of bacteriology. Methods: A total of 240 hospitalized patients from the Department of Cardiovascular Diseases, Xiangya Hospital, Central South University between November 2009 to July 2010 were randomly selected, and were divided into 3 groups according to the indwelling position and the indwelling time: a back of hand group(n=80), a forearm group(n=80) and a foot group(n=80). h e above 3 groups were also divided into 4 subgroups according to the indwelling time(T1: 48 h ≤ t < 72 h; T2: 72 h ≤ t ≤ 96 h; T3: 96 h < t ≤ 120 h; and T4: 120 h < t ≤ 168 h)(20 patients in each subgroup). h e bacteria of samples from puncture position of the skin were respectively cultured and identii ed at er skin disinfection, needle pulling out and sample puncture from the indwelling needle catheters, respectively. Results: 1) After the skin disinfection, there was no bacterium in the skin samples of puncture position. 2) When the needles were pulled out, there was bacterial growth in the skin samples of puncture position in 41 patients in the 3 groups, and the bacterium was not detected in samples of the 3 groups at T1 and T2 period. h ere was no signii cant dif erence in the positive rate of bacterial culture in the 3 groups at T3 and T4 period(P<0.05). 3) When the needles were pulled out. h ere was bacterial growth in the samples of indwelling needle catheters in 10 patients in the 3 groups; no bacterium was detected in the back of hand group and the forearm group at T1, T2, T3 and T4 period. In the foot group, there was no bacterium growth in the samples of indwelling needle catheters at T1 and T2 period, but there was bacterial growth in 4 patients at T3 period and in 6 patients at T4 period. h ere was signii cant dif erence in the positive rate of bacterial culture in the samples of indwelling needle catheters in the 3 groups(P<0.05). Conclusion: h e best indwelling position for peripheral venous indwelling needles is the forearm in patients with cardiovascular diseases.