聚维酮碘帽预防血液透析长期导管相关感染的临床研究

A clinical study on prophylactic efficacy of povidone iodine cap for long-term indwelling catheter-related infection in hemodialysis patients

目的评价自制聚维酮碘帽对血液透析患者长期透析导管相关感染的预防作用。方法入选湖北黄石市爱康医院肾内科符合条件的血液透析患者68例,随机分为3组,A组以0.5%肝素盐水封管+封管帽封盖导管出口,B组以0.4%庆大及0.5%肝素盐水封管+封管帽封盖导管出口,C组以0.5%肝素盐水封管+自制聚维酮碘帽封盖导管出口。随访1年观察导管相关感染事件,比较3组实验前相关指标及导管感染患病率,进行统计学分析。结果 C组患者平均年龄最高、血红蛋白最低,3组之间差异有统计学意义,P分别为0.045、0.001。实验6月时,3组发生导管相关性感染共13例(19.1%),B、C组与A组使用Fisher确切概率法检验,P=0.026,有统计学意义。12月时,A组发生导管相关性感染13例,B组6例,C组2例,χ2=7.510,P=0.023,差异有统计学意义,C组与A组之间差异有显著性,χ2=7.216,P=0.007。结论聚维酮碘局部应用可有效预防血液透析长期导管管内感染,从而延长导管寿命。

Objective To explore the preventive effect of povidone iodine cap for long-term indwelling catheter-related infection in hemodialysis patients. Method A total of 68 hemodialysis patients were randomly assigned into blank control group （group A, n=23） in which heparin cap was applied to seal catheter end and 0.5% heparin was used as the lock solution, condition control group （group B, n=23） in which 0.4% gentamycin/0.5% heparin was used as the lock solution, or the treatment group （group C, n=23） in which home-made povidone iodine cap was applied to seal catheter end and heparin was used as the lock solution. The presence of catheter-related infection was observed for one year, and the incidence was compared among the 3 groups. Result In the observation period of 6 months, catheter-related infection was 8, 3 and 2 cases in group A, B and C （P=-0.026）, respectively. In the observation period of 12 months, catheter-related infection was 13, 6 and 2 cases in group A, B and C （χ^2=7.510, P=-0.023）, respectively. Conclusion The povidone iodine cap can effectively reduce the long-term indwelling catheter-related infection in hemodialysis patients.