皮下隧道在预防深静脉导管感染中的应用

Application of Subcutaneous Tunnel in Prevention of Catheter-Related Infection

目的 观察皮下隧道在减少深静脉导管相关性感染（ｃａｔｈｅｔｅｒ—ｒｅｌａｔｅｄ ｉｎｆｅｃｔｉｏｎ Ｃ Ｒ Ｉ）中的作用。方法 采用连续样本，按区组随机化分组对照研究的方法将２６０ 例需施行深静脉穿刺置管术的老年患者分成两组。１３０ 例采用自创的经简便皮下隧道（长度５ｃｍ ）后股静脉置管（试验组），１３０ 例非经皮下隧道股静脉置管（对照组）。分别记录两组置管后局部皮肤感染例数、导管头细菌培养阳性例数和外周血细菌培养阳性例数。结果 试验组和对照组平均留管时间分别为２９９７±１２８１、２８９５±１０７９ 天，两组比较无显著性差异（ Ｐ＞ ００５）；试验组和对照组皮肤感染发生率分别为１０１％ 和９２％ ，组间亦无显著性差异（χ２＝ ００４， Ｐ＞ ００５），导管头感染发生率对照组６９％ 显著高于试验组１５％ （χ２＝ ４６５， Ｐ＜ ００５）。结论 经长度为５ｃｍ 的皮下隧道后深静脉置管在减少 Ｃ Ｒ Ｉ发生中有一定的作用。

Objective To observe the effect of subcutaneous tunnel on decreasing catheter-related infection(CRI). Methods A randomized control study was performed on 260 consecutive elderly patients with deep venous catheterization. A simplified subcutaneous tunnel method was used for 130 patients(trial group),and 130 others were catheterized with non subcutaneous tunnel(control group). The local skin infection cases were recorded. The skin catheter tip and peripheric blood culture were performed at the time the catheter was withdrawn. Results There was no difference in average duration of catheterization between the trial group (29.97±12.81 days) and the control group(28.95±10.79 days) (P>0 05). There wasn't significant difference for the local skin infection between the trial group(10.1%) and the control group(9.2%) (χ 2=0 04,P>0 05). The positive infection rate of the catheter tip culture of the control group was 6.9% which was obviously higher than that of the trial group 1.5%(χ 2=4 65,P<0 05). Conclusion Deep venous catheterization through subcutaneous tunnel which was 5cm long is beneficial to prevention of CRI. [