带涤纶套隧道血液透析导管相关感染临床分析

Clinical analysis of tunneled catheter-related infections in hemodialysis patients

目的回顾性分析带涤纶套隧道血液透析导管相关感染资料,探讨感染发生时间及细菌种类,导管感染发生率,抗生素治疗效果等,为有效防治导管相关感染提供理论依据。方法选择符合导管相关感染诊断标准的患者74例（85例次）,进行抗生素肝素盐水封管及静脉滴注抗生素,有出口感染及隧道感染的还进行局部换药。结果颈内静脉导管相关感染83例次,其中81例次为导管相关血流感染,2例次为皮肤出口及隧道感染；股静脉导管相关感染2例,均为导管相关血流感染。总的导管相关感染发生天数的中位数为368导管日,四分位间距为975导管日。金黄色葡萄球菌占检出细菌总数的32.94%。导管相关感染发生率在1年内为6.5例次/1000导管日,总的导管相关感染发生率为1.29例次/1000导管日。2例患者因基础疾病死亡,其余均临床治愈。结论带涤纶套隧道血液透析导管相关感染的患者,可使用敏感抗生素导管封管及静脉滴注抗生素治疗2-3周,无效者可拔管。检出细菌种类以金黄色葡萄球菌最常见。铜绿假单胞菌较其他菌种抗生素使用时间较长,导管相关感染发生率在1年内最高,带涤纶套隧道血液透析导管相关感染重在预防。

Objective To investigate the occurrence of tunneled catheter-related infection,bacterial species,and effect of antibiotic therapy in hemodialysis patients in order to provide a theoretical basis for effective prevention of tunneled catheter-related infection in hemodialysis patients. Methods A retrospective study was performed on 74 cases（85case-times）selected according to diag-nostic criteria of tunneled catheter-related infection and given antibiotics and heparinate from tube and antibiotics by intravenous drip.Tho patients with and tunnel infection were also given fresh dressing change for the irinfection sites of catheter exit and around.Results In 83case-timeswithvenajugu-laris intema tunneled catheter,there were 8 1 case-times of catheter-related blood stream infection,and 2 case-times of and tunnel infection.Both two case-times of femoral vein catheter-related infection were of blood stream infection.The median value of catheter-related infection days was 368,and the quartile range was 975 catheter day.32.94% infections were caused by staphylococcus aureus.Occur-rence rate of tunneled catheter-related infection was 6.5 episodes per 1 000 catheter days within 1 year and the total occurrence rate of tunneled catheter-related infection was 1 .29 episodes per 1 000 catheter days.All patients but 2 died from underlying diseases were clinically cured.Conclusions Patients with tunneled catheter-related infection were given sensitive antibiotics from tube and intravenous drip for 2 to 3 weeks,and the catheters were pulled out if infection was not controlled.Staphylococcus au-reus was the most common in detected bacterial species.In group of patients with pseudomonas aerug-inosa infection,the duration of antibiotic use was longer and the occurrence rate of tunneled catheter-related infection within 1 year was higher than in other groups.It was important for hemodialysis pa-tients to prevent tunneled catheter-related infection.