血液透析用中心静脉导管并发感染的相关因素分析及对策

Risk Factors for Central Venous Catheter-related Infections and Its Countermeasures

目的探讨血液透析中心静脉导管感染的相关影响因素及干预对策。方法回顾性分析2009年1月-2012年12月中心静脉留置双腔导管的725例患者中导管相关性感染的发生情况,并进行相关因素分析。结果 725例置管患者中15例发生导管相关性感染(2.0%),感染患者中1例为皮下隧道感染,隧道出口分泌物培养为金黄色葡萄球菌,血培养阴性;其余14例血培养阳性,其中金黄色葡萄球菌9例,大肠杆菌3例,无色杆菌1例,嗜麦芽窄食单胞菌1例。15例导管感染患者经抗菌药物治疗有效8例,抗菌药物治疗无效拔管者7例。结论中心静脉导管相关感染与医疗水平、导管留置部位、留置时间、透析充分性和患者全身情况、个人卫生密切相关,针对上述各个环节采取预防干预措施是减少感染的关键。

Objective To explore the risk factors for central venous catheter （CVC）-related infections and its Countermeasures, as CVC is an important vascular access for blood purification and is widely used in clinical applications, but catheter-related infection is one of the common severe complications. Methods We retrospectively analyzed the clinical data of 725 patients with complicated infections of indwelling center venous double lumen catheter treated between January 2009 and December 2012. Results Among all 725 cases, 15 had catheter-related infection. There were one case of subcutaneous tunnel infection （staphylococcus aureus by the secretion culture, negative for blood culture）, and 14 cases of positive blood culture including 9 staphylococcus aureus cases, 3 escherichia coli cases, 1 colorless bacillus case and 1 stenotrophomonas maltophilia case. Eight eases were cured by antibiotic therapy while antibiotics were invalid in the other 7 cases resulting in tube withdrawing. Conclusions The central venous catheter-related infections are related to medical service ability, catheter indwelling position, indwelling time, hemodialysis adequacy, patients＇ general condition and personal hygiene. Taking relative measures in view of each factor is the key to prevent infections.