应用苯唑西林控制血液透析中股静脉置管感染效果观察

Oxacillion is used to prevent the infections of thigh-vein indwelling catheter during hemodialysis

目的探讨应用苯唑西林联合肝素封管控制血液透析患者股静脉置管后感染的效果。方法 2004年1月-2005年5 月对股静脉置管血液透析患者分别采用苯唑西林与肝素联合封管法218例次,同时加强置管口处皮肤护理、使用导管时的无菌技术操作,并与常规肝素封管方法724例次进行感染情况比较。结果常规组724例次中发生感染27例次,感染率为3．7％,苯唑西林组218 例次中发生感染2例次,感染率为0．9％,有显著性差异(P<0．05)。感染的29例次患者中金黄色葡萄球菌感染者13例次占44．9％,表皮葡萄球菌感染者7例次占24,1％,肠球菌感染者5例次占17．0％,革兰氏阴性杆菌感染者4例次占14．0％。结论苯唑西林对金葡菌和表葡菌有良好的抗菌活性,能显著降低股静脉置管后的感染率。但对于苯唑西林无抗菌作用的肠球菌和革兰氏阴性杆菌则根据其药敏结果选用庆大霉素或庆大霉素加先锋霉素V再联合肝素封管可具有很好的抗菌活性,从而达到控制感染的目的。

Objective To observe the effect of oxacillion in prevent of infections of thigh-vein indwelling catheter during hemodialysis. Methods Tube sealing was conduced by combination of oxacillion and heparin for 218 time/cases for the hemodialysis patients during Jan. 2004 to May 2005. Then the skin punctured was cared intensively and another 724 case/time of sealing tube was conducted with only heparin. The infections were compared between the two groups. Results In the only heparin group, the patients had 27 case/time of infections, infection rate 3.7% while in the oxaeillion group of 218 time/case, there were 2 case/time of infections, accounting for 0.9%. The difference was significant （P〈0.05）. Of all the 29 infected cases, 13 time/cases were caused by staphylococcus aureus, accounting for 44.9%, 7 cases of infections by staphylococcus, accounting for 24.1%, 5 by enterocoecus, accounting for 17.0% and 4 by Gram-Negative bacillus, accounting for 14.0%. Conclusion Oxacillion can significantly lower the infection rate. But for enterococcus and Gram-Negative bacillus, oxacillion is ineffective and in this case, cidomycin or combination of it with heparin can be selected to seal the tube so as to control infections.