导管固定方法对深静脉置管相关性感染的影响

The affection of catheter fixation methods on deep venous catheter-related infections

目的探讨两种不同的深静脉导管固定方法对深静脉置管相关性感染的影响。方法观察深静脉置管术200例,其中观察组100例为单纯缝线固定,对照组100例为常规固定,每例分别采集导管前段3cm、穿刺点周围3cm皮肤拭子及对侧静脉血10ml作普通细菌培养,共采集标本600例次。分别记录两组置管后局部皮肤感染例数、导管前端细菌培养阳性例数和外周血细菌培养阳性例数,细菌培养菌株结果作对比分析。结果深静脉导管前段及穿刺点周围皮肤拭子细菌培养阳性率明显高于外周静脉血培养阳性率(x^2=19.205,P<0.05),深静脉导管前段及穿刺点周围皮肤拭子细菌培养病原体以G^+球菌为绝对优势株,而且两者细菌培养阳性菌株符合率较高,提示导管相关性感染为外源性。观察组和对照组平均留管时间分别为(29.97±12.81)d和(18.95±10.79)d,两组比较差异有统计学意义(P<0.05),穿刺点周围皮肤细菌培养阳性率、导管前端细菌培养阳性率、外周静脉血培养阳性率两组比较差异有统计学意义(P<0.05)。结论深静脉导管相关性感染病原体主要来源于皮肤正常寄殖菌,单纯缝线固定法固定导管对减少深静脉导管相关性感染发生和延长深静脉置管留置时间有一定作用,值得临床推广。

Objective To explore the affection of two different fixation methods of deep venous catheter on deep venous catheter-related infections. Methods Two deep catheter cases were observed. Of which 100 patients were observed for the simple suture fixation; another 100 cases were used for the control group for conventional fixation ; each case was collected swab o/preceding 3 cm of catheter and 3 em skin surrounding puncture point, contralateral venous blood 10 ml for common bacterial culture. The total collections were 600 specimens. The cases of localized skin inffections after intubation, the positive cases for bacterial culture of preceding catheter, the positive cases for bacterial culture of peripheral blood and the results of strains of bacterial culture were recorded respectively and analyzed. Results The positive rate of bacterial culture of swab of preceding deep venous catheter and skin surrounding puncture point was obviously higher than peripheral blood （χ^2 = 19. 205, P 〈 0. 05 ） , the bacterial culture pathogens of the swab of deep venous catheter and surrounding skin of puncture point were absolutely advantaged in G ~ coccobacteria. Both positive strains of bacterial culture were consistent with a higher rate, suggesting that catheter-related infections were exogenous. The average time of stay was （29. 97 ± 12. 81 ） days in observation group and （ 18. 95±10. 79） days in control group respectively. The difference was statistical significance （ P 〈 0. 05 ）. The positive rate of bacterial culture of skin surrounding the puncture point, preceding catheter and peripheral blood between two groups had significant difference （P 〈 0. 05）. Conclusion The pathogens of deep venous catheter-related infections mainly come from the normal skin bacteria colonization. Simple suture fixation to immobilize deep venous catheters has a certain role in reducing catheter-related infections and extending retention time of deep venous catheters, worthy of clinical practice.