静脉营养液中加入小剂量肝素预防新生儿中心静脉置管相关感染

Administration of low-dose heparin in total nutrient admixture prevents central venous catheter-related infections in neonates

目的经外周导入中心静脉置管(PICC)是危重新生儿长期静脉营养的有效途径之一,但导管相关性感染(CRI)是其常见并发症。本研究对全合一静脉营养液中加入微量肝素持续输注对PICC相关感染的预防作用进行观察,探讨减少CRI的有效措施。方法83例行PICC置管的患儿分为两组,肝素组(n=43)在营养液中加入肝素0.5U/mL,对照组(n=40)不加肝素,观察两组CRI的发生情况。结果肝素组发生导管堵塞2例(5%),对照组8例(20%);肝素组导管内细菌定植1例(2%),对照组7例(18%);肝素组无一例发生导管相关血流感染,对照组5例(13%),两组相比差异均有显著性(P<0.05)。结论静脉营养液中加入小剂量肝素可减少PICC堵管,预防CRI的发生。

Objective Peripherally inserted central catheter （PICC） is widely used to provide a long-term access for the administration of total parenteral nutrition and medications. Catheter-related infections （CRI） are common complications of PICC. The purpose of this retrospective study was to investigate the role of low-dose heparin added to the total nutrient admixture （CTNA） in the prevention of CRI. Methods Eighty-three neonates who underwent PICC received TNA with （heparin group, n =43） or without heparin （0.5 U/ mL） （control group, n =40）. The incidence of CRI was compared between the two groups. Results The incidences of catheter obstruction （5% vs 20% ） and the catheter-tip colonization （7.% vs 18% ） in the heparin group were significantly lower than those in the control group （ P 〈 0.05 ）. None of the neonates in the heparin group had clinical evidence of catheter-related bloodstream infection, but 5 cases in the control group （P 〈0.05）. Conclusions The administration of low-dose heparin in TNA may decrease the incidences of catheter obstruction and CRI.