神经外科患者中心静脉导管感染的相关因素分析及预防护理

Analysis of the factors to cause the infection related to central venous catheterization in neurosurgical patients and preventive nursing care

目的：探讨并分析神经外科患者中心静脉导管感染的相关因素及预防护理方法。方法：随机抽取560例行深静脉置管患者，于治疗结束后取导管尖端进行细菌培养，并对结果进行分析。结果：引起神经外科患者中心静脉导管感染的病原菌中，葡萄球菌占65．2％，真菌占16．7％；深静脉置管15～21d、22—28d、t〉29d患者导管感染发生率分别为24．5％、35．6％和65．3％；深静脉置管时间愈长，导管感染发生率越高（P〈0．01）；高血压性脑出血手术及开放性颅脑损伤患者导管感染发生率分别为14．8％、18．0％，均高于颅内肿瘤切除手术及化疗患者（P〈0．01）；锁骨下静脉穿刺置管及经贵要静脉穿刺置管患者感染发生率均低于颈内静脉穿刺置管患者（P〈0．01）。结论：严格深静脉置管护理和缩短留置时间对防止神经外科患者中心静脉导管感染具有重要临床意义。

Objective： To study and analysis the factors to cause the infection related to central venous catheterization in neurosurgical patients and preventive nursing care. Methods ： Bacterial culture of the catheter tip was done to 560 randomly se- lected patients with deep venous catheterization and the results were analyzed. Results： In the pathogen to cause central venous catheter- related infection, staphylococcus accounted for 65.2% , fungus accounted for 16.7% ; the incidence of catheter- related infection were respectively 24.5% , 35.6% and 65.3% according to the length of deep venous catheterization from 15 to 21 days, 22 to 28 days and over 29 days （ P 〈 0. 01） ; the incidence of catheter - related infection in patients with operation on hypertensive intracerebral hemorrhage and in patients with open craniocerebral injury were 14.8% and 18.0%, the incidence was higher than that in patients with intracranial tumor surgery and in patients with chemotherapy （P 〈 0. 01） ; the incidence of catheter - related infection was lower in subclavian vein and basilic vein catheterization than that in internal jugular vein catheterization （ P 〈0. 01 ）. Conclusion ： The strict nursing care and short indwelling time in deep venous catheterization were significant in the prevention of the infection related to central venous catheterization in neurosurgical patients.