全胃肠外营养患者中心静脉导管相关性感染的危险因素

Risk factors of central venous catheter-related infections in patients treated with total parenteral nutrition

目的研究全胃肠外营养患者(TPN)中心静脉导管相关性感染(CVC-RI)的危险因素,为安全有效的临床治疗提供科学依据。方法选取医院2010年1-12月45例经TPN治疗住院患者,选取经TPN治疗患者中发生中心静脉导管相关性感染者为感染组;无感染者为对照组;对其进行logistic回归性分析。结果选取的45例经TPN治疗患者中发生中心静脉导管相关性感染7例,总发生率为15.56%;单因素分析显示,感染组和对照组在年龄、TPN治疗时间、置管时间、置管类型、免疫抑制剂使用和是否入住ICU治疗的比较差异有统计学意义(P<0.05);根据多因素logistic回归分析,经TPN治疗患者出现CVC-RI的危险因素主要为年龄、TPN治疗时间、置管时间、置管类型、是否入住ICU治疗;其中年龄≥60岁占85.71%,TPN治疗时间≥5d占71.43%,置管时间≥4周占71.43%,使用三通管占71.43%,ICU治疗占71.43%。结论通过了解经TPN治疗患者中心静脉导管相关性感染因素,有利于医护人员对患者做出更加针对性的治疗,以减少患者感染的风险。

OBJECTIVE To investigate the risk factors of central venous catheter-related infections（CVC-RI） in patients treated with total parenteral nutrition （TPN）so as to provide scientific basis for safe and effective clinical treatment. METHODS A total of 45 patients who were treated with TPN from Jan to Dec 2010 were selected to undertake multivariate logistic regression, the patients with central venous catheter-related infections were set as the infection group, the patients without infections as the control group. RESULTS Of totally 45 patients treated with TPN, the CVC-RI occurred in 7 cases with the total incidence rate of 15.56%. Single factor analysis showed that there was significant difference in the age, time of treatment with TPN, catheter indwelling time, catheter type, use of immunosuppressant drugs, or stay in ICU between the infection group and the control group （P〈 0.05） ; while the multivariate logistic regression analysis indicated that the major risk factors which could lead to the CVC-RI in the patients with TPN treatment were the age, time of treatment with TPN, catheter indwelling time,catheter type, and stay in ICU. The patients with more than 60 years of age accounted for 85. 71%, the patients with TPN treatment time more than 5 days 71.43 %, the patients with catheter indwelling time more than 4 weeks 71. 43%, the patients using three-way pipe 71. 43%, and the patients with ICU stay 71. 43%. CONCLUSION Getting to know the risk factors of CVC-R1 in the patients with TPN treatment will help the doctors to undertake targeted treatment so as to reduce the incidence of infections.