极低出生体重儿PICC导管相关性血流感染的危险因素

The Study of Catheter-related Bloodstream Infection with PICC in Very Low Birth Weight Infants

目的探讨经外周置入中心静脉导管(percutaneously inserted central venous catheters,PICC)的极低出生体重儿发生导管相关性血流感染(catheter-related bloodstream infection,CRBSI)的危险因素。方法回顾性分析232例极低出生体重儿的临床资料,记录出生时体质量、胎龄、性别、PICC置入时体质量及日龄、置管部位(股静脉与非股静脉)及所需时间、PICC留置时间和CRBSI发生情况等,应用Logistic多元回归分析CRBSI与其他变量之间的关系。结果共有36例患儿(15.5%)发生CRBSI,发生率为5.1/1000导管日;多因素分析表明,留置股静脉部位、PICC留置时间和出生时体质量为CRBSI的独立危险因素。结论对于留置PICC的极低出生体重儿(尤其是体质量过低的患儿),尽可能避免股静脉插管、加强穿刺口护理以减少细菌定植、尽可能早期拔除PICC对于预防CRBSI具有重要意义。

Objective To investigate the risk factors of catheter-related bloodstream infection with PICC in very low birth weight infants. Methods The clinical data of 232 infants with very low birth weight were retrospectively analyzed. Birth weight, gestational age, gender, body weight and age in days when PICC was inserted, sites of PICC insertion （femoral site and non-femoral site）, time needed for PICC placement, duration of indwelling PICC and CRBSI were recorded. Logistic regression analysis was applied to assess the relationship between CRBSI and other variables. Results A total of 36 cases （15.5%） occurred CRBSI and the incidence of CRBSI was 5. 1/1000 catheter days. The time from the insertion of PICC to the occurrence of CRBSI was 15.9±7.6 days. Multivariate analysis showed that the indwelling site of femoral vein,PICC indwelling time and the birth weight were the indePendent risk factors of CRBSI. Conclusion We should avoid inserting a PICC at the femoral site as far as possible for the infants with very low birth weight. It is quite important to apply strict catheter care to reduce local site bacterial colonization and remove PICC as early as possible to prevent the incidence of CRBSI.