深静脉置管感染因素分析

Analysis on bacterial infection factors in deep venous catheterization

目的通过研究经皮穿刺深静脉置管术与感染的关系，分析深静脉置管导管相关性感染的发病率以及影响深静脉置管感染的相关因素以采取有效的防控措施降低感染的发生。方法采用回顾性调查方法，将2005年1月至2012年12月我院收治的60例深静脉置管患者按置管部位分为颈内静脉组26例和股静脉组34例，出现发热者采集导管内血培养及导管培养，对感染发生率、感染发生的时间、感染发生的部位、患者的血流量和不同病因患者感染发生率进行了统计。结果深静脉置管放置时间越长，导管相关性感染发生越多。股静脉穿刺组感染发生时间为（26．5±9．6）d，颈内静脉穿刺组感染发生时间为（35．4±6．8）d。本研究深静脉置管导管相关性感染发生率为21．67％，其中股静脉置管的感染发生率为32．3％，颈内静脉置管的感染发生率为7．6％，股静脉置管感染发生率远高于颈内静脉置管（P〈0．01）。在病因方面，糖尿病肾脏疾病组感染率为所有组别中最高（33．3％），与其他组比较存在显著差异（P〈O．05）。慢性肾小球肾炎组（16．7％），高血压肾动脉硬化组（16．7％），多囊肾病（14．2％）、狼疮肾炎（20％）之间无明显差异。患者血流量在200ml／min以上时，导管相关性感染的发生率较低，为9．5％；血流量〈200ml／min时，感染的发生率为28．2％，二者比较，存在显著差异（P〈0．05）。细菌培养病原体以革兰阳性球菌为主（53．85％），其中金黄色葡萄球菌占30．76％，表皮葡萄球菌占23．08％。结论为减少感染发生，颈内静脉置管应作为中心静脉置管的首选部位，导管留置时间应尽可能缩短。对有易感因素的患者，如原发病为糖尿病时血流量较低，应加强无菌操作，一旦发生感染，应立即治疗。

Objective Through studying the relationship between transcutaneous indwelling catheter in deep vein and catheterization-related infection to analyze the incidence rate of infection and related factors of catheter-related infetction to provide effective prevention and control measures to re- duce infection. Methods A retrospective survey from Jan 2005 to Dec 2012 was conducted in the he- modialysis center of the Second Peoples Hospital. Sixty chronic renal failure patients subject to cathe- terization in deep veins, among which 34 cases in femoral vein and 26 cases in interal jugular vein. Blood from the catheter and the catheter itself was collected for normal bacterial culture once the patients had fever. The incidence rate of infection, the infection time, the infection site, the blood flow of hemodial-ysis and the infection rate between patients of different causes were statisticed. Results The longer the time of catheterizing in deep vein was, the more correlated infection occurred. The infection time in femoral vein puncture group and interal jugular vein puncture group was （26. 5 ±9. 6） days and （35. 4 ± 6. 8） days respectively. The catheter-related infection rate in this study was 21.67%, of which the femoral vein catheter infection rate was 32. 3 %, and the internal jugular vein catheter infection rate was 7. 6%. The incidence of femoral vein infection was higher than the internal jugular vein infection（P〈 0. 01 ）. The infection rate in diabetic kidney disease group（33. 3 %） was significantly higher than other groups, including chronic glomerulonephritis group, hypertension group, polycystic kidney group andlupus nephritis group （P〈0. 05）. There was no significant difference among chronic glomerulonephri-tis group（ 16. 7 %）, hypertension group（ 16. 7 %）, polycystic kidney group（ 14. 2 %）, and lupus nephritis group（20%）. When blood flow was above 200 ml/min, catheter-related infection rate is 9. 5%, which was significantly lower than that under the blood flow of below 200 ml/min（28. 2%） （P〈0. 05）. In terms of bacterial culture, the pathogenic bacteria for catheterization-related infection were mainly the Gram-positive coccus, accounting for 52. 8 %, including Staphylococcus aureus accounting for 30. 76 %, Staphylococcus epidermidis accounting for 23. 08%. Conclusions Internal jugular vein puncture and a shorter time period of catheter indwelling are recommended to reduce the incidence of infection. For those patients with one or more risk factors of infection, such as low blood flow of hemodialysis or pa-tients with diabetes mellitus, more careful sterile operation is needed to prevent infection. Once the in- fection occurs, the patient should be treated immediately.