床旁B超在减少深静脉置管导管相关性感染中的应用

The Application of Ultrasound Guided Deep Vein Catheterization in Reducing Catheter Related Infection

目的应用床旁B超定位下进行深静脉置管,探讨其能否减少导管相关性感染(CRI)的发生率。方法选取2010年6月—2012年9月本院ICU收治的110例需要行深静脉置管的患者,随机分为两组:超声组(58例)患者在B超定位下进行深静脉置管;对照组(52例)患者在传统体位标志定位下进行深静脉置管,两组均采用相同的消毒措施。比较两组的置管时间、导管留置时间、一次性置管成功率、置管后机械性损伤发生率和提前拔管率及CRI、导管细菌定植(CBC)、相关性血行感染(CRBSI)发生率。结果超声组置管时间〔(29.8±9.3)s〕短于对照组〔(63.7±25.1)s〕,导管留置时间〔(14.2±4.5)d〕长于对照组〔(7.8±5.8)d〕,一次性置管成功率〔91.4%(53/58)〕高于对照组〔61.5%(32/52)〕,置管后机械性损伤发生率〔3.4%(2/58)〕低于对照组〔23.1%(12/52)〕(P<0.05);两组提前拔管率间无差异(P>0.05)。超声组因CRI拔管率(0)低于对照组〔7.7%(4/52)〕(P<0.05);而两组因CRBSI及非感染因素拔管率间无差异(P>0.05)。超声组CBC发生率〔8.6%(5/58)〕低于对照组〔25.0%(13/52)〕(P<0.05),G+球菌检出率〔5.2%(3/58)〕亦低于对照组〔23.1%(12/52)〕(P<0.05)。结论超声定位下深静脉置管能显著降低CRI、CBC发生率,且能延长导管留置时间,增加了置管操作的安全性。

Objective To evaluate whether ultrasound guided deep vein catheterization can reduce the incidence of catheter - related infection （CRI） . Methods From June 2010 to September 2012, a total of 110 patients in ICU of our hospital who needed deep vein catheterization were randomly divided into two groups： the ultrasound guided group （58 cases） and the control group （52 cases）, patients in the ultrasound guided group received ultrasound guided deep vein catheterization, patients in the control group received deep vein catheterization under guidance of traditional position mark, and the same disintection method was adopted by two groups. The operating time, indwelling time, catheterization one - time successful rate, mechanical injury incidence after catheterization, rate of extubation ahead of time, incidence of catheter bacterial colonization （ CBC）, CRI and catheter- related bloodstream infection （CRBSI） were compared between two groups. Results The operating time in ultra- sound guided group [ （29. 8 ＋9. 3） s3 was significantly shorter than that in control group [ （63.7 ＋25.1 ） s~, the indwelling time in ultrasound guided group [ （ 14. 2 ＋4. 5） d3 was significantly longer than that in control group [ （7.8 ＋5.8） d~, cath- eterization one -time successful rate in ultrasound guided group [ 91.4% （53/58） 3 was significantly higher than that in control group [61.5% （32/52） 3, mechanical injury incidence after catheterization in ultrasound guided group [3.4% （2/58） 3 was significantly lower than that in control group [ 23. 1% （12/52） ], extubatioh rate caused by CRI in ultrasound guided group （0） was significantly lower than that in control group [7.7% （4/52） ], the CBC incidence in ultrasound guided group [8. 6% （5/58）] was significantly lower than that in control group [ 25.0% （13/52） 3, gram positive cocci detection rate in ultrasound guided group [5.2% （3/58）] was significantly lower than that in control group [23.1% （12/52） ] （P 〈0. 05） . There were no significantly differences in rate of extubation ahead of time and extubation rate caused by CRBSI and noninfectious factors be- tween two groups （P 〉 O. 05） . Conclusion The ultrasound guided deep vein catheterization can reduce the incidence of CRI and CBC, prolong indwelling time, and increase the safety of catheterization operation.