老年患者不同途径中心静脉置管感染的比较

A Comparison of Infections Caused by Central Venous Catheterization by Different Ways

目的比较分析经锁骨下静脉、颈内静脉穿刺置入中心静脉导管(central venous catheter,CVC),与经周围静脉穿刺置入中心静脉导管(peripherally inserted central catheter,PICC)发生感染情况,为老年患者选择适合的、感染几率小的静脉置管方式提供依据。方法回顾分析我科2005年3月—2008年10月置入中心静脉导管的老年患者发生导管相关感染情况,分为经锁骨下静脉或颈内静脉穿刺组(Ⅰ组)和经周围静脉穿刺组(Ⅱ组),每组各129例,统计两组患者局部感染、导管细菌培养阳性率、导管源性菌血症、导管留置时间和相关并发症的情况。结果Ⅰ组较Ⅱ组的局部感染率、导管细菌培养阳性率、导管源性菌血症高(P<0.01),Ⅰ组较Ⅱ组的导管留置时间短(P<0.01),Ⅰ组较Ⅱ组的相关并发症发生多。结论经周围静脉穿刺置入中心静脉导管相关感染及并发症发生率较低、中心静脉导管留置时间较长,PICC是适合老年患者的中心静脉置管方式。

Objective To provide the basis for suitable venous catheterization with less probability of infection for elderly patients by comparing the incidence of infections caused by central venous catheterization through the subclavian vein and internal jugular vein and PICC. Methods A retrospective analysis was made of the incidences of infections caused by venous catheterization with the elderly patients hospitalized between Mar. 2005 and Oct. 2008, who were divided into Group Ⅰ （catheterization through the subclavian vein and internal jugular vein） and Group Ⅱ （catheterization through peripheral vein）, each with 129 cases. Then a comparison was made of the patients＇ local infection, result of catheter bacteria cultivation, catheter-originated bacteremia, duration of catheter retaining and related complications. Results The rates of local infection, positivity demonstrated in catheter bacteria cultivation and catheter-originated bacteremia of Group Ⅰ was higher than those of Group Ⅱ （P〈0.01）, the duration of catheter retaining of the former, shorter than that of the latter（P〈0.01）, and the complications occurring in the former, more than those in the latter. Conclusion PICC had fewer incidences of infections and complications and longer duration of catheter retaining and thus is a suitable way of venous catheterization for elderly patients.