降低导管相关性感染超声定位深静脉置管的临床研究

Clinical study of deep vein catheterization under ultrasonic location in reducing catheter-related infections

目的探讨医院多中心超声定位下深静脉置管,以降低医院导管相关性感染(CRI)的临床研究。方法随机选取医院2012年12月-2013年12月进行多中心超声定位下深静脉置管患者138例为观察组;另选取同时期在传统体位标定下进行深静脉置管患者100例为对照组,分析两组患者深静脉置管时间、感染类型及病原菌种类。结果观察组患者置管时间、留置导管时间及一次置管成功率、机械损伤率分别为(31.3±10.9)s、(15.2±4.9)d及90.5%、4.3%,对照组分别为(67.5±20.1)s、(67.5±20.1)d及24.0%、27.0%,两组相比差异有统计学意义(P<0.05);两组患者感染类型主要为导管细菌定植、出口部位感染及导管相关性血流感染,观察组患者发生感染8例,感染率为5.8%,对照组患者发生感染19例,感染率为19.0%,两组相比差异有统计学意义(P<0.05);两组患者感染病原菌分布差异有统计学意义(P<0.05)。结论医院多中心超声定位下深静脉置管CRI发生率显著低于传统体表定位,能减少置管时间,增加留置时间,减小创伤并提高置管成功率,因此临床可以广泛应用。

OBJECTIVE To investigate deep vein catheterization under multi‐center ultrasonic location so as to re‐duce catheter‐related infections in hospitals .METHODS Totally 138 patients who received deep vein catheterization under multi‐center ultrasonic location from Dec .2012 to Dec .2013 were randomly selected as observation group . Another 100 cases treated with deep vein catheterization under traditional location method in the same period were chosen as control group .The time of deep vein catheterization ,infection types and bacterial variety were analyzed and compared between the two groups .RESULTS In observation group ,the catheterization time was （31 .3 ± 10 .9） s ,indwelling catheter time was （15 .2 ± 4 .9） d ,and successful rate of first catheterization was 90 .5% ,and the mechanical damage rate was 4 .1% .In the control group ,the data were （67 .5 ± 20 .1） s ,（67 .5 ± 20 .1） d , 24 .0% and 27 .0% .The difference was significant（P〈0 .05） .The main infection types in the two groups were catheter bacterial colonization ,exit site infections and catheter‐related bloodstream infections .In the observation group ,eight cases were infected and the infection rate was 5 .8% ,while in the control group ,the number was 19 and the infection rate was 19 .0% . The difference between the two groups was significant （ P 〈 0 .05 ） . CONCLUSION CRI incidence rate in patients with deep vein catheterization under multi‐center ultrasonic location was significantly lower than that of the tradition method .And deep vein catheterization under multi‐center ultra‐sonic location can reduce catheterization time ,increase indwelling time as well as minimize trauma and improve successful rate ,hence can be widely used in clinical practice .