超声引导锁骨下静脉精确置管对危重患者导管相关性血流感染的影响

Effect of ultrasound-guided subclavian vein accurate catheterization on preventing catheter-related bloodstream infection in critically ill patients

【摘要】目的探讨超声引导锁骨下静脉精确置管对危重患者导管相关性血流感染（CrtBSI）中的影响。方法将2008年1月一2013年1月在海南省农垦总医院ICU治疗需要留置中心静脉导管的患者随机分成超声组（超声引导下锁骨下静脉精确置管）和对照组（f专统锁骨下静脉穿刺法置管），比较两组患者穿刺成功率、并发症发生率、导管相关眭血流感染的发生率和病原菌分布情况。结果超声组中14．6％患者既往存在置管困难，90％患者不能处于正常置管体位，与对照组比较，差异有统计学意义，P〈0．05。与对照组比较，超声组穿刺成功率明显提高，而尝试进针次数和并发症明显减少，P〈0．05。超声组患者导管相关性血流感染率和千导管日感染率明显低于对照组（10．8％VS16．8％，11．0％ovs17．1‰，P〈O．05）。两组患者分离病原菌以革兰阳性菌为主，占47．1％，革兰阴性菌，占38．2％。两组间比较，超声组凝固酶阴性葡萄球菌比率明显低于对照组（11．5％VS33．3％，P〈0．05），其他病原菌分布差异均无统计学意义，P〉0．05。结论超声引导锁骨下静脉穿刺精确置管成功率高，并发症少，能明显降低危重患者CRBSI的发生率。

Objective To evaluate the effe.ct of uhrasound-guided subclavian vein accurate catheterization on reducing catheter-related bloodstream infection （CRBSI） in critically iU patients. Methods A total of 490 cases of critically ill patients admitted in the ICU in between Jan. 2008 and Jan. 2013 who needed intravascular catheterization were randomly divided into the ultrasound group （ultrasound-guided subclavian vein accurate catheterization） and the control group （subclavian vein catheterization in traditional way）. The followings were analyzed between the two groups, baseline characteristics, the success rate of catheterization, the complications during catheterization, incidence of CRBSI and the distribution of the pathogens. Results 14.6% patients in the ultrasound group had previous difficulties during cannulation, and 90% of them was not in the trendelenburg position, reflecting a significant difference comparing with the control group, P 〈 0.05. Success rate was significantly higher, whereas the number of attempts and the rate of mechanical complications were significantly lower in the ultrasound group, P 〈 0.05. The inddence of CRBSI and the rate of CRBSI per 1000 catheter days in the ultrasound group was significantly lower than those of the control group （10.8% vs. 16.8%, 11.0%~ vs. 17.1%,, P 〈 0.05. CRBSI pathogens in patients of two groups were mainly consisted of Gram-positive cocci （47.1%） and Gram-negative bacilli （38.2%）. The incidence of coagulase negative Staphylococcus in patients of the ultrasound group was significantly lower than that of the control group （11.5% vs. 33.3%, P 〈 0.05）. Other pathogenic distribution between the two groups reflected no statistically significant difference, P 〉 0.05. Conclusion Ultrasound-guided subclavian vein accurate catheterization is considered being effective in carrying out higher success rate and less complications which may obviously reduce the incidence of CRBSI in critically ill patients.