中心静脉导管相关性血流感染21例临床分析

Clinical analysis of intravascular catheter-related bloodstream infection in neonatal intensive care unit

目的 探讨中心静脉导管相关性血流感染（CRBSI）的临床特征和发病因素.方法 对新生儿重症监护病房发生的21例CRBSI患儿的临床资料进行回顾性分析.结果 胎龄28～34周、出生体质量＜1 500 g、导管留置时间在3周以上的早产儿是CRBSI的高发人群,以喂养不耐受、不明原因的心率加快、体温不稳、应激性血糖升高及顽固性代谢性酸中毒为主要临床表现.感染的病原以凝固酶阴性的葡萄球菌为主（35.7%）,其次分别为肺炎克雷伯杆菌（11.9%）、金黄色葡萄球菌（9.5%）、铜绿假单胞菌（7.1%）及阴沟肠杆菌（7.1%）.结论 CRBSI患儿临床表现隐匿,缩短导管留置时间及胃肠外营养时间、加强全身的营养支持是预防CRBSI的有效措施.

Objective To find out the clinical characteristics and morbility factors of intravascular catheterrelated bloodstream infection（CRBSI）. Methods Totally 21 patients who had CRBSI in neonatal intensive care unit were investigated retrospectively. Results The distribution of CRBSI was higher in very low birthweight preterm infants, gestational age among 28 ～34week, whose intravascular catheter remaining time were obove three weeks. Principal clinical presentation of CRBSI were poor feeding, unaocountable tachycardia, temperature instability, stressed hyperglycemia,refractoriness metabolic acidosis. The most common pathogens were coagulase-negative staphylococci （35.7%）, Klebsiella pneumonia, bacilli （ 11.9% ） Staphylococcus aureus （9.5 % ）, Pseudomonas aeruginosa（ 7. 1% ）and Enterobacter cloacae（7.1% ）. Conclusions The clinical manifestations of CRBSI were concealment,and reducing the time of inserted central catherization and total parenteral nutrition, strengthening the nutrition of body would provide effective prevention of CRBSI.