ICU中心静脉导管相关性感染的危险因素研究

Risk factors for central venous catheter-associated infections in ICU

目的研究中心静脉导管相关性感染(CRBSI)的危险因素,为临床控制中心静脉导管相关性感染提供参考。方法回顾性分析2012年1月-2013年6月医院不同重症监护病房(ICU)3 320例行中央静脉置管患者资料,调查CRBSI患者的危险因素,并应用单因素χ2、多因素logistic回归进行统计分析。结果 3 320例中心静脉置管患者中有98例发生感染,感染率为2.95%,主要集中在呼吸科ICU、外科ICU及神经内科ICU,感染率分别为38.78%、44.90%及9.18%;住ICU≥30d、股静脉置管、非急诊入院、有输血、住院天数≥30d等与导管相关性感染的发生存在密切的相关性,两组差异有统计学意义(P<0.05);多因素分析结果显示,住ICU≥30d、股静脉置管、非急诊入院、中心静脉置管≥30d、使用呼吸机≥30d、气管置管≥2次是感染发生的独立危险因素(P<0.05)。结论导致中心静脉导管感染与多种因素密切相关,在临床工作中应加强重点科室患者的防护,针对多因素结果采取相应的防护措施,以降低深静脉置管的感染率。

OBJECTIVE To explore the risk factors for central venous catheter‐associated infections so as to provide guidance for clinical control of central venous catheter‐associated infections .METHODS The clinical data of 3 320 patients who underwent central venous catheterization in different intensive care units （ICUs） from Jan 2012 to Jun 2013 were retrospectively analyzed ,then the risk factors for the central venous catheter‐associated infections were investigated ,and the univariate chi‐square test and the multivariate logistic regression analysis were per‐formed .RESULTS The infections occurred in 98 of 3 320 patients who underwent the central venous catheterization with the infection rate of 2 .95% ,among whom 38 .78% were in the ICUs of respiratory department ,44 .90% in the ICUs of surgery department ,9 .18% in the ICUs of neurology department .The incidence of the catheter‐asso‐ciated infections was closely associated with the no less than 30 days of ICU stay ,femoral vein catheter indwell‐ing ,non‐emergency admission to the hospital ,blood transfusion ,and no less than 30 days of hospital stay ,there was statistically significant difference between the two groups （P〈0 .05） .The results of the multivariate analysis indicated that the length of ICU stay no less than 30 days ,femoral vein catheter indwelling ,non‐emergency admis‐sion to the hospital ,duration of central venous catheter indwelling no less than 30 days ,time of use of ventilator no less than 30 days ,and endotracheal intubation more than two times were the independent risk factors for the in‐fections （P〈0 .05） .CONCLUSION The incidence of the central venous catheter‐associated infections is closely as‐sociated with multiple factors ;it is necessary for the hospital to strengthen the protection of the patients in key de‐partments and take corresponding prevention measures against the risk factors so as to reduce the incidence of deep venous catheter‐associated infections .