早产儿外周中心静脉置管相关性感染的危险因素与防控策略

The risk factors and control strategies of catheter-related infection in preemie with peripherally inserted central catheter

目的探讨早产儿外周中心静脉置管（PICC）相关性感染的发生率、危险因素，以利于实施预防措施，有效控制感染的发生。方法258例出生体重小于2．5kg行PICC的早产儿，根据有无发生导管相关性感染（CRI）分为CRI组与非CRI组，把两组胎龄、出生体重、PICC时间、胃肠外营养时间和PICC时胃肠外营养时间进行统计学分析以及比较不同置管时间CRI发生情况。结果确诊CRI24例，发生率9．3％（24／258）。CRI组平均胎龄、出生体重、PICC时间、胃肠外营养时间、PICC时胃肠外营养时间分别为29．5周、1．4kg、31．5d、40．1d、28．8d，非CRI组分别为33．0周、1．8kg、14．6d、16．7d、13．4d，两组比较差异有统计学意义（P〈0．01或〈0．05）。不同置管时间CRI发生率比较差异有统计学意义（P〈0．01）。发生CRI的危险因素包括胎龄（P=0．007）、出生体重（P=0．000）、PICC时间（P=0．001）、胃肠外营养时间（P=0．035）、PICC时胃肠外营养时间（P=0．001）。多因素Logistic回归分析显示影响最大的3个因素是出生体重、胃肠外营养时间、胎龄。结论胎龄、出生体重、PICC时间、胃肠外营养时间是导致PICC患儿发生CRI的危险因素。

Objective To study the incidence rate and risk factors of catheter-related infection （CRI） in preemie with peripherally inserted central catheter （PICC）, in order to facilitate the implementation of control strategies and control infection. Methods Two hundred and fifty-eight PICC preemie of birth weight less than 2.5 kg, according to whether the incidence of CRI were divided into CRI group and non CRI group,two groups of gestational age, birth weight,PICC time, parenteral nutrition time and PICC parenteral nutrition time were statistically analyzed and compared different indwelling time of CRI incidence. Results Diagnosis of CRI in 24 cases,the occurrence rate of 9.3%（24/258）. There were significant differences in gestadonal age,birth weight,PICC time,parenteral nutrition time,PICC parenteral nutrition time between CRI group and non CRI group （29.5 weeks vs. 33.0 weeks, 1.4 kg vs. 1.8 kg,31.5 days vs. 14.6 days,40.1 days vs. 16.7 days,28.8 days vs. 13.4 days,P〈 0.01 or 〈 0.05）. There was significant difference in incidence rate of CRI among different indwelling time （P〈 0.01 ）. The risk factors of CRI including gestational age （P= 0.007） ,birth weight （P = 0.000） ,PICC time （P = 0.001 ） ,parenteral nutrition time （P = 0.035 ） ,PICC parenteral nutrition time （P = 0.001 ）. Multivariate Logistic regression analysis showed the greatest impact on the 3 factors were birth weight, parenteral nutrition time, gestational age. Conclusion Gestational age, birth weight, PICC time, parenteral nutrition time are the risk factors of CRI in preemie with PICC.