肿瘤患者经外周静脉置入中心静脉导管发生导管相关感染危险因素分析

Risk factors of peripherally inserted central catheter-related infection in tumor patients

目的探讨肿瘤患者经外周静脉置人中心静脉导管（peripherally inserted central catheter，PICC）发生导管相关性感染的影响因素。方法2736例经外周静脉置人PICC的肿瘤患者，发生导管相关感染者206例为感染组，未发生导管相关感染者2530例为未感染组，比较2组一般资料和导管留置时间，多因素logistic回归分析引起导管相关感染的危险因素。结果2736例患者导管总留置时间为203356导管日，发生导管相关感染206例，感染发生率为1．01／1000导管日（7．53％）；感染组导管留置时间[（76．24±40．01）导管日]与非感染组[（74．17±35．51）导管日]比较差异无统计学意义（P〉0．05）；2组年龄、置管季节、单次置管穿刺次数、导管移动、化疗次数、白细胞计数、导管留置时间和是否伴有糖尿病差异均有统计学意义（P〈0．05）；导管移动（OR=3．24，95％CI：2．86-3．47，P：0．00）、化疗次数（OR=2．87，95％cj：2．55-3．29，P=0．00）、白细胞计数（OR=2．36，95％cI：1．89-2．54，P=0．00）及伴有糖尿病（OR=2．67，95％CI：1．96-2．53，P=0．00）是发生PICC导管相关感染的独立危险因素。结论加强导管维护标准化、增强患者机体免疫机能及防治基础疾病等措施，可有效预防和减少肿瘤患者PICC导管相关感染的发生。

Objective To study the risk factors for peripherally inserted central catheter （PICC）-related infection in tumor patients. Methods A total of 2 736 tumor patients undergoing PICC were divided into infection group with PICC- related infection （n=206） and non-infection group with no PICC-related infection （n=2 530）. The clinical data and PICC indwelling time were compared between two groups. The risk factors of PICC-related infection were analyzed by univariate and multivariate analysis. Results The total PICC indwelling time of 2 736 cases was 203 356 catheter days, P1CC-related infection occurred in 206 patients with the infection rate of 1.01/1 000 catheter-days （7.53 %）. There was no significant difference in PICC indwelling time between infection group （（76. 24 ± 40. 01） catheter-days） and non- infection group （（74. 17±35. 51） catheter-days） （P〉0.05）. Two groups showed significant differences in the age, season, puncture times in once catheter, catheter movement, chemotherapy times, white blood count （WBC）, catheter time and diabetes （P〈0.05）. Logistic regression analysis showed that catheter movements （OR： 3.24, 95 %CI： 2.86 to 3.47, P=0.00）, chemotherapy times （OR=2.87, 95%CI： 2.55 to 3.29, P=0.00）, WBC （OR=2.36, 95%CI： 1.89 to 2.54, P=0.00）, and diabetes （OR=2.67, 95%CI： 1.96 to 2.53, P=0.00） were the independent risk factors for PICC-related infection. Conclusion To strengthen the standardization of catheter maintenance, enhance patient＇s immunity and prevent and treat the basic diseases can effectively reduce the incidence of PICC-related infection.