不同糖脂供能比肠外营养对中心静脉导管感染的影响

The impact of parenteral nutrition of different glycolipids energy supply ratio on central venous catheter infections

目的探讨不同糖脂供能比的肠外营养对危重病患者中心静脉导管相关性感染(CRI)发生的影响。方法将200例经中心静脉导管行肠外营养的患者,根据其糖脂供能比分为A组(糖脂供能比4∶6)、B组(糖脂供能比5∶5)、C组(糖脂供能比6∶4)行肠外营养支持。比较分析三组患者CRI发生率、CRI病原菌谱。结果 200例肠外营养患者中发生CRI 17例(8.50%);三组CRI发生率比较,差异有统计学意义(P<0.01);C组感染率最高,与A、B组比较,差异有统计学意义(均P<0.0125);共培养出菌株31株,其中G+菌14株、G-菌12株、真菌5株,主要致病菌为革兰阳性菌。结论肠外营养患者CRI发生与肠外营养液糖脂供能比密切相关,过高的葡萄糖供能会增加中心静脉导管感染的风险。在提供足够热量的前提下,应考虑由脂肪乳提供相对较多的能量,降低肠外营养支持患者CRI的发生率。

Objective To explore the prevalence of catheter related infection（CRI）in patients receiving parenteral nutrition（PN）with different glycolipids energy supply ratio.Methods A total of 200 patients who were admitted to intensive care unit and received PN were enrolled in this study.According to the different ratio of energy supply in PN,the patients were divided into group A with a glycolipids energy supply ratio 4∶6,group B with a ratio 5∶5and group C with a ratio 6∶4.The incidence of CRI and spectrum of pathogens were compared among the three groups.Results Of these 200 patients,17had CRI,with the incidence rate of 8.5%.There were significant differences in the incidence rates of CRI among the three groups,with group C of the highest infection rate（P〈0.01）.Fourteen strains of gram positive bacteria,12 strains of gram negative bacteria,and 5strains of fungi were found,among which,the most pathogenic was gram positive bacteria.Conclusion CRI occurs,in patients receiving PN is closely related to glycolipids energy supply ratio.Extremely high energy provided by glucose may increase the risk of central venous catheter infection.Under the premise of providing sufficient calories,more energy should be considered to be provided from fat emulsion to reduce the incidence rate of CRI in patients receiving PN.