老年肿瘤患者PICC相关性感染的因素分析

Elderly cancer patients PICC-related infections factors

目的探究老年肿瘤患者经外周静脉置入的中心静脉导管(PICC)相关性感染的因素及病原学特点,为临床治疗提供依据。方法选取武汉大学人民医院2012年1月至2014年1月收治的进行PICC置管的老年肿瘤患者265例,分析PICC相关性感染的易感因素,并对感染的致病菌进行培养分析。结果输注液体为胃肠外营养(TPN)的患者感染率20.31%,要高于非TPN患者的9.45%;导管留置时间大于60 d的患者的感染率为19.57%,高于小于60 d患者的8.09%;导管维护过的患者感染率为9.85%,小于未维护患者的19.35%;春秋季节行PICC置管的患者的感染率为7.34%,低于夏冬季节的15.38%;肿瘤早期患者的感染率为5.13%,低于肿瘤中晚期患者的14.97%;有并发症患者的感染率为17.21%,高于无并发症患者的7.69%;以上6项差异均有统计学意义(P<0.05)。通过对PICC相关感染易感因素的Logistic回归分析,输注液体、导管留置时间、导管维护、季节、肿瘤分期、并发症是PICC导管相关性感染的危险因素(OR=2.414、3.163、4.212、2.017、1.541、1.127)。结论输注液体、导管留置时间、导管维护、季节、肿瘤分期、并发症是PICC导管相关性感染的危险因素。

Objective To explore the peripherally inserted central venous cathetersl（PICC）-related infections in elderly cancer patients predisposing factors and pathogenic characteristics,and provide basis for the prevention and treatment of infection. Methods 265 cases of PICC of the elderly cancer patients in People＇s Hospital of Wuhan University from January 2012 to January 2014 were enrolled for thi study. Risk factors of the PICC related infections,and pathogenic bacteria were analyzed. Results The infection rate of patients with total parenteral nutrition（TPN） infusion was 20.31% and was significantly higher than that of non-TPN patients（9.45%）（P 0.05）;patients with indwelling catheter infusion longer than 60 days was 19.57%,significantly higher than that of less than 60 days（8.09%）（P0.05）; infection rate of patients using catheter with maintenance was 9.85%,and was significantly lower than that using catherter without maintenance（19.35 %）（P0.05）.The average infection rate in spring and autumn（7.34%） was significantly lower than that of summer and winter（15.38%）（P0.05）. Infection rate of early cancer patients was（5.13%） significantly lower than that of the advance cancer patients（14.97%）（P0.05）. Infection rate of patients with complication（17.21%） was significantly higher than that without complication（7.69%）（P0.05）. Conclusion The infusion of fluids,cathetering time,catheter maintenance,seasonal,tumor stage,and PICC catheter-related complications were infection predisposing factors.