血透患者中心静脉置管的感染因素分析及防治

Analysis and Prevention of Central Vein Catheter Infection in Hemodialysis Patients

目的:分析血透患者中心静脉置管的感染因素。方法:对437例中心静脉置管患者的感染发生情况,按置管部位、时间、病因及导管的通畅度等因素进行分析。结果:股静脉置管的感染率高于颈内静脉和锁骨下静脉;糖尿病肾病患者的感染率明显高于其它病因;置管时间越长,感染率越高。而导管血流量是否充足对感染发生无显著影响。结论:为减少感染发生,颈内静脉或锁骨下静脉置管应作为中心静脉置管的首选部位,导管留置时间在病情允许的情况下应尽可能缩短。对那些有易感因素的患者,如股静脉置管,病情需要不得不长期留置导管或合并糖尿病的患者,要更加严格无菌操作,提高护理质量,才能有效预防感染发生。

Objective： To analyze the factors of central vein catheter infection in hemodialysis patients and prevention of catheter infection. Methods： We observed 437 patients in our hemodialysis center who re- ceived central vein puncture and catheter placement to establish hemodialysis vascular access in recent years. We analyzed the incidence rate of infection according to different puncture site, time period of catheter in- dwellingj cause of renal failurej and blood flow conditions. Results：Catheters placed in femoral vein have a higher risk of infection than placed in internal jugular vein and subclavian vein. Those whose renal failure were caused by diabetic nephropathy are easier to occur catheter associated infection than the other cause of kidney function loss such as chronic glomerular nephritis j acute renal failure and renal arteriolar sclerosis etc. Furthermore j the longer period of catheter indwelling, the higher incidence of infection occurrence. However, there ＇ s no significant difference of infection occurrence in these patients no matter blood flow of the catheter is sufficient or not. Conclusion： Internal jugular vein or subclavian vein puncture and a shorter time period of catheter indwelling are recommended to reduce the incidence rate of infection. For those pa- tients with one or more risk factors of infection, such as catheter placed in femoral vein, a need of catheter for long term indwelling, and for those patients with diabetes mellitus, more careful sterile operation are needed to prevent infection.