老年肠外营养相关中心静脉导管微生物定植及危险因素分析

Risk factors for parenteral nutrition associated central venous catheter related microorganism colonization in elder patients

目的:研究老年病人肠外营养(PN)相关中心静脉导管(CVC)微生物定植(MC)的发生率和危险因素。方法:回顾性分析我院老年(≥60岁)住院病人。病人均禁食,通过CVC接受PN,拔管后进行导管尖端培养。采集病史资料、导管相关资料(放置部位、留置时间和培养结果)和PN相关指标(使用时间、输注液量、每天提供热量和PN液能量密度)。结果:204例老年病人入选本研究。总置管时间为2 983 d。MC发生率为20.6%(42/204),千导管日发生率为14次/千导管日(42/2 983 d)。Logistic回归分析显示,血清肌酐和前清蛋白水平、PN液能量密度、其他部位存在感染等是PN相关MC的危险因素。最常见的CVC定植微生物为革兰阳性球菌(50.0%),其次为革兰阴性杆菌(33.3%)和真菌(6株,14.3%)。机会致病菌占总微生物数的23.8%(共10株)。结论:血清肌酐水平降低以及输注能量密度较高的PN液,易导致老年病人发生MC。

Objective： To analyze risk factors for parenteral nutrition（PN） associated central venous catheter（CVC） related microorganism colonization（MC） in elder patients.Methods： A retrospective study was performed.Inclusion criteria： ①age≥60 years;② PN via CVC;③Catheter tip cultured after removal.Patient＇s medical factors,catheter related data,PN related data were also collected.Isolation of microorganisms in the distal segment of catheter≥15 CFU/ml was defined as MC.Results： 204 elder patients（M/F： 138/66） met inclusion criteria.Total duration of use of CVC was 2 983 days and median PN duration was 7.5 days（2~49 days）.The MC rate was 20.6%（42/204） or 14/1 000 catheter-day.Risk factors for MC were creatinine,prealbumin,energy density for PN fluid,and other infections by Logistic analysis.Conclusion： Decreased serum creatinine and increased energy density for PN fluid raises the possibility of MC in CVC of elder patients.