心脏术后中心静脉导管感染的原因分析及干预措施的研究

Causes of central venous catheter-related infections after cardiac surgery and intervention measures

目的分析心外科中心静脉导管感染的原因,探讨其干预措施。方法选择100例心外科手术患者,术后均行中心静脉导管置管。结果 100例患者发生中心静脉导管感染22例,感染率为22.0%,其中包括表皮葡萄球菌感染6例、金黄色葡萄球菌感染5例、肺炎克雷伯菌感染4例、粪肠球菌感染3例,鲍氏不动杆菌、阴沟肠杆菌、白色假丝酵母菌及铜绿假单胞菌感染各1例;均根据药敏试验结果给予相应抗菌药物治疗,感染症状消失;中心静脉压感染年龄≤50岁者感染率为12.5%、>50岁者感染率为26.5%,二者比较差异有统计学意义(P<0.05);无并发症者感染率为9.1%、有并发症者感染率为28.3%,二者比较差异有统计学意义(P<0.05);锁骨下静脉穿刺者感染率为17.8%、颈内静脉刺激、穿刺者感染率为21.8%,二者比较差异无统计学意义;导管接头和封管液优化者感染率为17.6%、常规者感染率为37.5%,二者比较差异有统计学意义(P<0.05);导管种类为双腔者感染率为21.4%、三腔者感染率为27.3%,二者比较差异无统计学意义;置管时间:<7d者感染率为9.1%、7～10d感染率者为20.0%、>7d者感染率为40.7%,三者比较差异有统计学意义(P<0.05)。结论术前积极处理并发症、缩短置管时间及根据药敏试验应用抗菌药物,可防治中心静脉导管感染。

OBJECTIVE To analyze the causes of central venous catheter-related infections after the cardiac surgery and to explore the intervention countermeasures.METHODS A total of 100 patients who underwent cardiac surgery were selected,and all the patients underwent the central venous catheterization.RESULTS Of the 100 patients investigated,the central venous catheter-related infections occurred in 22 patients with the infection rate of 22.0%,including 6 cases of Staphylococcus epidermidis infections,5 cases of S.aureus infections,4 cases of Klebsiella pneumoniae infections,3 cases of Enterococcus faecalis infections,1 case of Acinetobacter baumannii infection,1 case of Enterobacter cloacae infection,1 case of Candida albicans infection,and 1 case of Pseudomonas aeruginosa infection.The infections disappeared after being given appropriate antibiotics on the basis of drug susceptibility testing.The incidence rate of the central venous catheter-related infections in the patients with less than 50 years of age was 12.5%,and 26.5% of the patients with more than 50 years,the difference was statistically significant（P0.05）.The infection rate of the patients without complications was 9.1%,and 28.3% of the patients with complications,the difference was statistically significant（P0.05）.The infection rate of the patients with the subclavian vein as puncture site was 17.8%,and 21.8% of the patients with internal jugular vein as the puncture site,the difference was not statistically significant.The infection rate of the patients with the joints and sealing solution optimized was 17.6%,the conventional 37.5%,the difference was statistically significant（P0.05）.The infection rate of the patients with dual-chamber was 21.4%,27.3% of the patients with three-cavity,the difference was not statistically significant.The infection rate of the patients with the catheterization duration less than 7 days was 9.1%,20.1% of the patient with the duration between 7 days and 10days,and the 40.7% of the patients with the duration more than 7days,the difference was statistically significant（P 0.05）.CONCLUSION To treat the complications actively before the surgery,shorten the catheterization duration,and use antibiotics based on the drug susceptibility testing can prevent the central venous catheter-related infections.