中心静脉导管在骨髓造血干细胞移植应用中的并发症及其护理

Complications and Nursing of Central Venous Catheters Undergoing Hematopoietic Stem Cell Transplantation

目的探讨中心静脉导管在骨髓造血干细胞移植（hematopoietic stem cell transplantation,HSCT）应用中的并发症类型、发病率、危险因素,进一步探讨护理人员如何防止中心静脉导管（Central venous catheters,CVC）并发症。方法收集本院2007-10-2013-10间100例患儿在HSCT中使用CVC的临床资料。结果共出现186次导管并发症,并发症发生率为14.6次/1000 CVC-days。良性血液病导管并发症高于恶性血液病导管并发症（χ2=5.2,P=0.02）。CVC功能障碍发生率为1.7次/1000 CVCdays（11.8%,n=22）,机械性损坏为0.07次/1000 CVC-days（0.5%,n=1）;CVC感染发生率为11.9次/1000 CVC-days（81.2%,n=151）,男患儿导管出口部位感染（CRI）发生率高于女患儿（χ2=6.42,P=0.01）。9根（7.9%）CVC导管发生感染导管被移除,70根（61.4%）导管治疗后被移除。经多变量分析,患有非血液疾病CVC并发症发生率高于血液疾病CVC并发症发生率（OR=2.66,CI=1.1-6.2）。男患儿CRI危险性几乎是女患儿的2.5倍（P=0.01,OR=2.68,CI=1.2-5.8）。结论护理人员必须掌握CVC并发症并不断学习CVC的指导方针和实践标准,严格执行无菌技术,具有能够处理CVC各个方面的能力。

Objective To explore the types , incidence and risk factors of the complications related to CVC used in children undergoing HSCT,and to explore how nurses should have a greater awareness of the prevention of complications .Methods Medical records were analyzed on 100 patients with CVC between October 2007 and October 2013.Results Overall , 186 complications were documented.The overall complication rate was 14.6/1000 CVC -days.Catheter complications were higher in nonmalignant disorders than hematological malignancies （χ2 =5.2, P=0.02）.CVC malfunction rates were 1.7/1000 CVC-days （11.8%, n=22） and 0.07/1000 CVC-days for mechanical complications （ 0.5%, n=1 ）.The overall CRI rate was 11.9/1000 CVC-days （ 81.2%, n=151 ）.CRI episodes were higher in male than female children （χ2 =6.42, P=0.01）.Nine CVC （7.9%） were removed due to infection, 70（61.4%） were removed at the end of therapy.In children who had nonhematological diseases , the rate of complications of CVC were higher than in those with hematological diseases （ odds ratio [ OR]=2.66 , concidence interval [ CI]=1.1~6.2.The risk for CRI in male children was nearly 2.5 times more compared with female children （ P =0.01 , OR =2.68 , CI =1.2 ~5.8 ）.Conclusion Nurses must be aware of CVC complications and must follow guidelines and practice standards continuously.Rigorous attention should be paid to the aseptic technique . These are essential in all aspects of appropriate management of CVC.