不明原因发热患者保留观察和立即拔除中心静脉导管的临床研究

Keep watching versus immediately remove central venous catheter in unexplained fever patients

目的研究不明原因发热患者保留观察中心静脉导管的安全性以及是否能够减少不必要的导管拔除。方法回顾性分析82例不明原因发热怀疑导管相关性感染同时临床状况相对稳定患者，分为保留观察中心静脉导管组（观察组）31例和立即拔除中心静脉导管组（拔除组）51例。比较两组患者的ICU病死率、序贯器官功能衰竭评估（SOFA）评分、最高体温、导管相关性感染发生率和中心静脉导管拔除率。结果两组患者的ICU病死率、SOFA评分、最高体温和导管相关性感染发生率的差异均无统计学意义（P〉0．05）；观察组有11例（35．5％）中心静脉导管最终给予拔除，同拔除组100．0％的中心静脉导管拔除率相比，差异有统计学意义（P〈0．05）。结论不明原因发热患者临床怀疑导管相关性感染，如果患者临床状况相对稳定，保留观察中心静脉导管方案可以减少相当多的不必要导管拔除，同时也不会恶化患者预后。

Objective To evaluate the safety of keeping watching central venous catheter and whether it decreased unnecessary catheter removal in unexplained fever patients. Methods Eighty-two unexplained fever patients with suspected catheter-related infection whose clinical conditions were relatively stable were retrospectively analyzed and divided into keep watching group （31 patients ） and immediate removal group （51 patients ）. ICU mortality, sequential organ failure assessment （SOFA） score, temperature, the rate of catheter-related infection, and the rate of central venous catheter removal were compared. Results There was no significant difference in ICU mortality, SOFA score, temperature and the rate of catheter- related infection between two groups （P 〉 0.05）. Eleven of 31 （35.5%） were removed central venous catheter at last, versus all patients （ 100.0% ） in the immediate removal group （P 〈 0.05 ）. Conclusion Keep watching central venous catheter will decrease a substantial unnecessary catheter removal without increased morbidity in unexplained fever patients with suspected catheter-related infection if their clinical conditions are relatively stable.