3种敷贴在儿科中心静脉维护中的效果与成本比较

Comparison on the effectiveness and cost of three type dressings in the maintenance of pediatric central venous catheters

目的比较3种敷贴在儿科中心静脉维护中的效果及医疗成本消耗。方法将61例留置中心静脉导管的患儿随机分入A组、B组和C组,分别采用透明敷贴、含碘敷贴及高通透敷贴进行敷贴更换。在7d的观察期内,3组采用不同的敷贴、使用标准流程进行敷贴更换。每天评估穿刺部位的局部感染及导管相关血流感染发生率;留置后第7天留取穿刺点皮肤表面细菌培养;记录研究周期内各组敷贴更换次数及相关医疗费用。结果 3组均未发生中心静脉导管相关血流感染,3组局部感染率的差异无统计学意义(P>0.05)。B组中心静脉导管局部皮肤细菌定植率为15.0%,低于A组(63.6%)和C组(52.6%),3组皮肤细菌定植的发生率差异有统计学意义(χ2=10.83,P=0.004)。B组敷贴更换次数及相关医疗费用高于A组及C组,差异有统计学意义(P<0.05)。结论含碘敷贴抑制中心静脉穿刺局部皮肤的细菌定植效果良好;高通透敷贴抑制细菌定植的效果差些,但具有很好的粘贴力;透明敷贴抑制细菌定植效果最差,且粘贴力差,不推荐在儿科中心静脉维护中使用。

Objective To compare the effectiveness and medical cost of three type dressings in the maintenance of pediatric central venous eatheters（CVC）. Methods Sixty-one children with CVC were randomly assigned to transparent dressing group, iodine plus dressing group and high-permeable dressing group. The incidence of CVC insert site infection and CVC-related infection was recorded every day,the CVC insertion site bacterial culture was done on the seventh day,the times of dressing change and dressing related medical cost were recorded. Results The incidence of CVC-related infection was zero in all three groups and no significant difference in the incidence of CVC insertion site among the three groups（P〉0.05）. The bacterial colo- nization rate of CVC insertion site in the iodine plus dressing group was 15.0%,which was significantly lower than that of the transparent dressing（63.6%） and the high-permeable dressing group（52.6%）. The times of dressing change and medical cost in the iodine plus dressing group were significantly higher than the other groups（P〈0.05）. Conclusion Iodine plus dressing has the best effect in reducing the growth of bacterial colonization in CVC of pediatric patients,high-permeable dressing has powerful sticky,but the effect in reducing the growth of bacterial colonization was poor than iodine plus dressing,the transparent dressing has poor effect in reducing the growth of bacterial colonization and is not recommended in the maintenance of pediatric CVC.