不同输液接头应用于中心静脉导管相关性血流感染的对比研究

Effects of different infusion connectors on central venous catheterassociated bloodstream infections:a comparative study

目的探讨使用中心静脉导管置入术(PICC)治疗中应用不同输液接头对相关性血流感染率的影响,为临床应用提供依据。方法选取2013年1月-2014年1月实施PICC治疗患者339例,按数学随机方法分为机械阀组、肝素帽组、分隔膜组,每组各113例,3组患者分别实施对应输液接头治疗,对比3组患者感染率、发生时间、插管天数,并对感染患者实施病原菌检测。结果 339例患者中发生感染43例,感染率12.68%;分隔膜组患者相关性血流感染发生率为2.65%,机械阀组为18.58%,肝素帽组为16.81%,分隔膜组与其他两组比较,差异均有统计学意义(P<0.05),机械阀组与肝素帽组比较差异无统计学意义;分隔膜组感染患者平均插管天数为(10.47±0.79)d,优于其他两组,对比差异均有统计学意义(P<0.05);共分离出病原菌45株,其中革兰阳性菌29株占64.44%,以金黄色葡萄球菌、表皮葡萄球菌为主,革兰阴性菌16株占35.56%,以鲍氏不动杆菌、大肠埃希菌、铜绿假单胞菌为主。结论分隔膜类输液接头发生相关性血流感染率明显较低,且导管使用时间长;同时PICC相关性血流感染中革兰阳性菌是主要病原菌,应根据药敏结果选择有效抗菌药物治疗。

OBJECTIVE To explore the effects of different infusion connectors on central venous catheter‐associated bloodstream infections in the patients undergoing peripherally inserted central venous catheterization （PICC） so as to provide guidance for clinical application .METHODS A total of 339 patients who underwent the PICC from Jan 2013 to Jan 2014 were enrolled in the study and randomly divided into the mechanical valve group ,the heparin cap group ,and the separation membrane group ,with 113 cases in each group .The three groups were respectively trea‐ted with the corresponding infusion connectors .The infection rate ,onset time ,and intubation duration were ob‐served and compared between the three groups ,and the pathogens causing infections were detected .RESULTS The infections occurred in 43 of 339 patients ,with the infection rate of 12 .68% ;the incidence of the catheter‐associat‐ed bloodstream infections was 2 .65% in the separation membrane group ,18 .58% in the mechanical valve group , 16 .81% in the heparin group;as compared with the separation membrane group with other two groups ,there was significant difference （P〈0 .05） ,there was no significant different between the mechanical valve group and the heparin cap group .The average intubation duration of the separation membrane group was （10 .47±0 .79） days , significantly better than that of other two groups（P〈0 .05） .A total of 45 strains of pathogens have been isolated , including 29（64 .44% ） strains of gram‐positive bacteria and 16 （35 .56% ） strains of gram‐negative bacteria;the Staphylococcus aureus and Staphylococcus epidermidis were dominant among the gram‐positive bacteria ,and the Acinetobacter baumannii , Escherichia coli ,and Pseudomonas aeruginosa were the predominant gram‐negative bacteria .CONCLUSION The incidence of the catheter‐associated bloodstream infections is relatively low in the pa‐tients who use separation membrane infusion connector ,and the time of use of catheter is long .The gram‐positive＆amp;nbsp;bacteria are the predominant pathogens causing the PICC‐associated bloodstream infections ,and it is necessary to reasonably use antibiotics based on the results of drug susceptibility testing .