老年恶性肿瘤患者肠外营养相关中心静脉导管感染的危险因素分析

Parenteral nutrition related central venous catheter infection in elder patients with malignant tumors

目的研究老年恶性肿瘤患者肠外营养相关中心静脉导管感染的发生率及危险因素。方法回顾性分析366例术后行肠外营养的老年恶性肿瘤患者的临床资料,采集患者的年龄、性别、体质量、原发疾病诊断、手术方式、既往史、输血量、输注白蛋白量、体温超过38℃天数以及肠外营养相关指标,包括肠外营养使用时间、总热能、非蛋白热能、脂肪乳剂、蛋白质和葡萄糖用量、非蛋白热能与氮比值以及糖脂比。结果366例患者的平均年龄(71.8±6.9)岁,肠外营养时间(10.6±6.3)d,总导管留置时间3 336 d。肠外营养相关中心静脉导管感染发生率为2.5%(9/366)。Logistic回归分析显示,接受肠外营养前白蛋白水平和体温升高天数与中心静脉导管感染的相对危险度分别为1.257和2.518(均P<0.01)。结论老年恶性肿瘤患者接受肠外营养前白蛋白水平和体温升高天数是肠外营养相关中心静脉导管感染发生的危险因素。

Objective To investigate the prevalence of parenteral nutrition related central venous catheter infection in elder patients with malignant tumors, and explore the risk factors. Methods The clinical data of 366 patients with malignant tumors who were managed with parenteral nutrition after operation were retrospectively analysed. The data of age, gender, body weight, diagnosis of primary disease, surgical approach, past history, volume of blood and albumin transfusion and time of fever （body temperature ≥38 ℃ ） were collected. Parenteral nutrition related parameters such as time of parenteral nutrition, total calorie, non-protein calorie, amount of fat, protein and glucose, calorie to nitrogen ratio and carbohydrate to fat ratio were also recorded. Results The mean age of 366 patients was （71.8 ± 6.9） years, mean time of parenteral nutrition was （ 10.6 ±6.3） d, and total time of catheterization was 3 336 days. The prevalence of parenteral nutrition related central venous catheter infection was 2.5% （9/366）. Logistic regression analysis demonstrated that the relative risks of plasma albumin level before parenteral nutrition and time of high fever to catheter infection were 1. 257 and 2. 518, respectively （P 〈 0.01 for both）. Conclusion Plasma albumin level before parenteral nutrition and time of fever were two risk factors for parenteral nutrition related catheter infection in elder patients with malignant tumors.