ICU患者经不同途径留置中心静脉导管发生感染分析

Analysis of the infection caused by central venous catheterization in ICU patients

目的比较分析ICU患者经不同途径留置中心静脉导管发生的感染，筛选出一种安全可靠的中心静脉留置途径。方法回顾性分析温州医学院附属第二医院ICU病区2005—12—2008—12期间留置中心静脉导管的ICU患者984例，其中经股静脉放置172例次，经颈静脉放置430例次，经锁骨下静脉放置382例次。观察导管感染情况，比较不同途径留置的中心静脉导管发生感染的差异。结果经股静脉途径留置的中心静脉导管感染率为13．1％，经锁骨下静脉途径感染率为3．2％，经颈静脉途径感染率为6．4％，三种途径导管感染率比较差异有统计学意义（P〈0．01）；三种途径导管3d内感染率比较差异无统计学意义（P〉0．05）；三种途径导管7、14d感染率比较差异均有统计学意义（均P〈0．01），且随时间延长而增加；中心静脉导管感染的致病菌以革兰阳性菌为主，真菌少见。结论①ICU患者中心静脉留置导管的感染率与留置途径及时间有一定相关性，经锁骨下静脉留置导管发生感染率最低；随置管时间延长，感染率增加；②中心静脉导管感染的致病菌以革兰阳性菌为主，革兰阴性菌和真菌少见。

Objective To compare the differences of infection caused by central venous catheterization with different ways in order to choose a safe way. Methods To review the 984 patients in the Intensive Care Unit of our Hospital from December 2005 to December 2008. They were treated through femoral vein for 172 times, through subclavian vein for 382 times, and through jugular vein for 430 times. The infection rates of central venous catheterization with various approaches were compared. Results ① The infection rate of central venous catheterization was 13.1% in the patients through femoral vein, 3.2% through subclavian vein, 6.4% through jugular vein. The differences of infection rate of central venous catheterization with various ways were significant （ P 〈 0.01 ）.② The 3 - day infection rate showed no differences among the three ways （ P 〉 0.05 ） , but significant differences were found on 7th and 14th day （ all P 〈 0.01 ）, which increased with the prolong of the time. ③Gram - positive bacteria were the main pathogenic bacterium in the infection of central venous catheterization and the fungus was seldom. Conclusion ① There is a relationship between the infection rate of central venous catheterization and the way and the time. The infection rates of subclavian vein are the lowest and increase with the long of time. ② Gram - positive bacteria are the main pathogenic bacterium in the infection of central venous catheterization. The Gram -negative bacteria and fungus were seldom.