急性白血病患者PICC置管相关性感染因素及对策分析

Analysis and measurement the factors of PICC related infection in acute leukemia

目的:分析急性白血病患者经外周静脉置入中心静脉导管(peripherally inserted central catheter,P I C C)相关性感染因素,为有效防治提供理论依据。方法:选取保定市第一医院2 0 0 9年8月至2015年6月100例急性白血病患者及100例实体肿瘤患者行PICC置管,分析急性白血病PICC置管相关性感染发生率及原因。结果:100例急性白血病发生PICC置管相关性感染患者21例,置管相关性感染发生率为21.00%,其中局部感染12例,占12.00%,全身性感染9例,占9.00%;明显高于实体肿瘤患者10.00%(10/100),P<0.05,与患者年龄、性别、急性白血病类型、选择静脉、置管长度无显著相关。而中性粒细胞计数<0.5×109/L、粒细胞缺乏时间≥7 d,CD4/CD8<1.00、置管留置时间≥60 d患者置管相关性感染发生率明显升高。结论:白血病患者PICC置管相关性感染明显高于实体肿瘤患者,其中与中性粒细胞计数、粒细胞缺乏时间,CD4/CD8比值、置管留置时间密切相关,因此对急性白血病患者要严格执行PICC操作流程及无菌操作以减少患者置管相关性感染发生率。

Objective： To analyze infection factors of peripherally inserted central catheter（PICC） in patients with acute leukemia and provide theoretical basis for effective prevention and treatment of the infection. Methods： 100 acute leukemia patients and 100 solid tumor patients with PICC catheter were selected in the No. 1 Hospital of Baoding from June 2015 to August 2009. The incidence and infection factors of PICC catheter were analyzed. Results： The PICC catheter-related infections account to 21 cases in 100 acute leukemia patients, including 12 cases of local infection（12.00%）, 9 cases of systemic infection（9.00%） which was significantly higher than that solid tumors with 10.00%（10/100）, P〈0.05. The risk of infection has no correlation with age, gender, types of acute leukemia, intravenous selection and catheter length; the infection rate increased in patients with the neutrophil count 0.5×109/L, agranulocytosis time ≥7 days, and CD4/CD8 1.00, intubation time ≥60 days. Conclusion： The PICC related infection in leukemia patients was significantly higher than that in solid tumor patients. The infection has a correlation with neutrophil count, agranulocytosis time, CD4/CD8 ratio, intubation time. So the strict implementation with PICC operation process and aseptic operation was important to reduce the catheter related infection incidence in acute leukemia patients.