内科住院患者中心静脉置管感染危险因素调查分析

Risk factors of central venous catheter-related infections in hospitalized patients of internal medicine department

目的探讨内科住院患者中心静脉置管(PICC)感染的相关危险因素,为其临床防治提供参考依据。方法采用回顾性研究方法选择120例医院内科系统的住院患者,采用统一的调查表详细记录相关信息,根据病情所有患者均给予PICC,根据其是否发生感染分为两组,应用多因素回归分析进行分析。结果 120例患者中有20例患者发生PICC感染,感染发生率为16.7%;其中导管尖端培养阳性10例,8株分离菌中4株为革兰阳性菌、3株为革兰阴性菌、1株为真菌;20例发生感染的患者中,局部定植16例,局部感染3例,菌血症1例;PICC发生感染组导管留置时间、导管管径≥16G、导管多腔、有糖尿病史、使用抗菌药物分别为(10.0±1.2)d、70.0%、70.0%、75.0%、70.0%,明显高于未感染组患者的(6.2±1.3)d、45.0%、45.0%、50.0%、45.0%,而血清白蛋白的水平(29.0±3.2)g/L明显低于未感染组患者的(36.9±4.2)g/L,两组间比较差异有统计学意义(P<0.05)。结论内科住院患者PICC发生感染与导管留置时间的延长、导管管腔的增加、合并糖尿病及血清白蛋白水平的低下存在密切的相关性,是其发生的独立危险因素,在临床工作中需对上述因素进行必要的干预。

OBJECTIVE To explore the risk factors associated with the central venous catheter （PICC） infections in the hospitalized patients of the internal medicine department so as to provide basis for the clinical prevention and treatment. METHODS A total of 120 patients who hospitalized the internal medicine department were retrospectively analyzed, the unified questionnaires were used to record relevant information in detail, all the patients underwent the PICC and were divided into two groups according to the infection status, then the multivariate analysis was performed. RESULTS Of 120 cases of patients,the PICC infections occurred in 20 cases with the infection rate of 16.7% ,among which there were 10 cases with catheter tip cultured positive. Of 8 strains of isolated bacteria,there were 4 strains of gram-positive bacteria, 3 strains of negative bacteria, and 1 strain of fungi. Of 20 cases of patients with infections, there were 16 cases with local bacterial colonization, 3 cases with local infections,and 1 case with bacteremia. The catheter indwelling duration, pipe diameter more than 16 G, multi-cavity catheter, diabetes history, and the use of antibiotics of the patients with PICC were respectively（10.0± 1.2）d, 70.0%, 70.0%, 75.0%, and 70.0%, significantly higher than （6.2±1.3）d, 45.0%, 45.0%, 50.0% , and 45.0% of the patients without PICC infections. The serum albumin level of the patients with PICC infections was （29. 0 ±3.2）g/L,significantly lower than （36.9±4.2）g/L of the patients without infections,the difference between the two groups was statistically significant （P〈 0. 05）. CONCLUSION The incidence of the PICC infections in the hospitalized patients of internal medicine department is closely related to the extension of catheter indwelling duration, increase of the catheter cavity, diabetes mellitus, and low level of serum albumin, which are the independent risk factors, thus the hospital should take necessary interventions to the risk factors.