新生儿经脐静脉中心静脉置管相关感染的临床研究

Umbilical venous catheterization related infection in the neonatal intensive care unit

目的了解新生儿经脐静脉中心静脉置管(UVC)相关性感染的发生率以及感染病原菌。方法对112名出生体重大于1500g、出生24h内行UVC的新生儿,于置管后即时做血培养及置管后24h和1周的脐根部皮肤拭子细菌培养。置管相关性感染定义为"脐轮持续红肿超过24h或置管后明显腹胀,或无原因精神反应差,或血培养阳性"。结果置管相关性感染率为8.9%。所有标本的细菌培养总阳性率为9.4%,置管后24h和1周脐根部皮肤表面拭子细菌培养阳性率分别为7.1%和16.2%。革兰阳性菌与革兰阴性菌的所占比例分别为55.2%和44.8%,革兰阳性菌中以B族链球菌为主,革兰阴性菌中以肺炎克雷伯杆菌和大肠杆菌为主。结论 UVC与新生儿院内感染之间存在一定的关联,UVC相关感染病原菌中,革兰阳性菌与革兰阴性菌所占比例相似。

Objective To study the incidence and pathogens of umbilical venous catheterization（UVC）related infection in the neonatal intensive care unit（NICU）.Methods A total of 112 neonates（birth weight 1 500 g）who received UVC within 24 hrs after birth were included.Blood culture was performed right after UVC.At 24 hrs and 1 week after UVC,umbilical skin scrub cultures were performed.Skin redness and swelling for more than 24 h,or severe abdominal distension,or poor general condition for unknown reason after UVC,or positive blood culture results,were the criteria for catheterization related infection.Results The incidence rate for UVC related infection was 8.9%.Total culture positive rate was 9.4%.At 24 hrs and 1 week after UVC,the umbilical skin scrub culture positive rate was 7.1% and 16.2%,respectively.Rate of Gram positive and Gram negative pathogens was 55.2% and 44.8%,respectively.Group B Streptococcus was main Gram positive pathogen.Klebsiella and E.coli were the main Gram negative pathogens.Conclusions UVC is,to some extent,related to nosocomial infection in the NICU.Among UVC related infection,Gram positive and Gram negative pathogens take almost the chance.