神经危重症患者中心静脉置管感染相关因素分析及护理对策

Analysis of the related factors causing PICC infection in critically ill patients in neurosurgical department and nursing countermeasures

目的：分析神经外科ICU中心静脉置管相关感染因素,并提出相应的护理对策。方法：回顾性分析2008年1月-2012年12月42例经锁骨下中心静脉置管感染的患者住院资料进行调查研究,分析引起置管感染的相关因素。结果：我科经锁骨下中心静脉置管的感染率为9.29%。NICU中心静脉置管相关感染主要包括：患者导管留置时间、颅脑损伤程度、血糖水平、置管人员技术水平及置管时机等。42例感染患者中总计培养菌株69株,其中革兰阳性菌38株（55.07%）,革兰阴性菌26株（37.68%）,真菌5株（7.25%）。发生导管相关感染的患者预后情况较未发生导管相关感染的患者差（P〈0.05）。结论：严格控制中心静脉导管留置时间,严格无菌操作,针对中心静脉置管感染的相关因素,制定合理的预防和护理措施对减少中心静脉置管相关感染的发生具有重要临床意义。

Objective：To analyze the related factors causing PICC infection in critically ill patients in neurosurgical department and put forward nursing countermeasures. Methods：The hospitalization data and information of 42 patients who received subclavian PICC（from January 2008 to December 2012）were retrospectively analyzed to find out the related factors causing PICC infection. Results：The infection rate of PICC was 9. 29% in our department and it mainly included indwelling time of catheter,the degree of traumatic brain injury,blood glucose level,the skill of nurses and the time of catheterization. A total of 69 strains were cultured in 42 patients with infection,of which 38 strains were gram negative bacilli（55. 07% ）and 26 strains were gram positive bacilli（37. 68% ）,5 strains were fungi（7. 25% ）. The prognosis of patients with catheter - related infection was poor compared with those who were not infected（P 〈 0. 05）. Conclusion：The strict control of the indwelling time of catheter,strict aseptic operation,the targeted and reasonable prevention and nursing measures has important clinical significance for reducing the occurrence of catheter - related infection.