血管内留置导管感染的相关因素分析及预防对策

Analysis of factors related to infection of intravascular indwelling catheter and preventive counter-measures

目的探讨与静脉导管感染的相关因素以及预防对策。方法分析598例中心静脉留置导管患者的临床资料，对可疑静脉导管感染者130例行导管留置的时间、部位、细菌学监测。结果留置导管时间为3-70d。其中77例占12．88％血培养和导管尖端微生物学培养阳性。共检出病原菌151株；革兰阴性菌48株占31．79％，革兰阳性菌78株占50．65％，真菌25株占16．56％。其中，最常见的病原体是表皮葡萄球菌、金黄色葡萄球菌、念珠菌、不动杆菌；大多数细菌具有高度耐药性。部位的选择：锁骨下静脉和贵要静脉导管相关感染率低于股静脉、锁骨上静脉和颈内静脉，置管时间≤13d的静脉导管相关感染率低于≥14d的。结论选择锁骨下静脉和贵要静脉行静脉置管术，规范穿刺技术、严格置管护理、缩短留置时间和改善患者全身隋况可减少导管相关性感染。合理使用抗生素，是降低危重病患者血管内导管感染的重要措施。

Objective To explore the factors related to infections of intravenous catheter as well as preventive measures. Methods In 598 cases of patients with central venous catheterization, in- dwelling time, location, bacteriology were monitored among 130 patients with suspected venous catheter infection. Results IndweUing catheter lasts for 3 days at least, 70 days at most. For 77 out of total cases, microbiology culture of catheter tip and blood culture were positive, accounting for 12.88%. Detected pathogens were 151 in total. Gram-negative bacteria were 48 （31.79%）, gram-positive bacteria were 78 （50.65%）, fungal were 25 （16.56%）. Among these, the most common pathogens were Staphylococcus epi- dermidis, Staphylococcus aureus, Candida and Aeinetobaeter, most of the bacteria had a high degree of drug resistance. The choice of position： infection rate of subclavian vein and basilic vein was lower than that of the superelavian vein and internal jugular vein, infection rate of catheterization time ≤ 13d was lower than that of≥ 14d. Conclusions The choice of subclavian vein and basilie vein, standardization of puncture technical, strict catheter care, shortening of catheterization time and improvement of the general condition of patients can reduce catheter-related infections. The rational use of antibiotics is a critical measure to reduce vascular catheter infections of patients.