ICU患者PICC导管相关性感染影响因素分析及应对措施

Influences and countermeasures of catheter-related bloodstream infections with peripherally inserted central catheters in ICU

目的分析ICU患者PICC导管相关性感染（CRBSI）的影响因素。方法选取2014年10月至2016年12月外科ICU符合条件的PICC置管患者164例，分析患者一般资料、输注药物以及皮肤情况等对PICC的CRBSI的影响。 结果CRBSI患者16例，非CRBSI患者148例，CRBSI患者急性生理学和慢性健康状况Ⅱ（APACHEⅡ）评分、ICU住院时间、ICU内PICC置管时间分别为（22.25 ± 4.95）分、（99.44 ± 57.34）d、（67.44 ± 48.30）d，非CRBSI患者分别为（14.64 ± 6.86）分、21.00（22.00）d、12.00（14.00）d，两者比较差异均有统计学意义（U=439.00、299.00、383.00，均P〈0.01）；CRBSI患者输注血管活性药物和皮肤水肿的发生情况分别占8/16、10/16，非CRBSI患者分别占25.00%（37/148）、31.08%（46/148），两者比较差异有统计学意义（χ2=4.53、6.34，均P〈0.05）。APACHEⅡ评分是PICC导管相关性感染的独立危险因素（OR=1.21，P〈0.01）。结论ICU内环境复杂，患者病情多变，评估CRBSI的影响因素为ICU内PICC的护理提供指导，尽可能降低CRBSI的发生率，从而提高患者生命质量。

To analyze the influences of catheter related bloodstream infection （CRBSI） for ICU patients with PICC.MethodsInformation and documents of 164 PICC patients were collected from October 2014 to December 2016, general information, intravenous drugs and skin conditions were analyzed if they have any impacts on CRBSI.ResultsSixteeen patients with CRBSI and 148 patients with non-CRBSI. The acute physiology and chronic health evaluation （APACHE Ⅱ） score, hospitalization time, PICC catheterization time was （22.25 ± 4.95） points, （99.44 ± 57.34） d, （67.44 ± 48.30） d in CRBSI patients, and （14.64±6.86） points, 21.00（22.00） d, 12.00 （14.00） d in non-CRBSI patients. There were significant differences （U=439.00, 299.00, 383.00, all P〈0.01）. The incidence of injection of vasoactive drugs and skin edema were accounted for 8/16, 10/16 in CRBSI patients, and 25.00%（37/148）, 31.08%（46/148） in non-CRBSI patients, the difference was statistically significant （χ2=4.53, 6.34, P〈0.05）. The APACHE II score was an independent risk factor for PICC catheter-related infections （OR=1.21, P〈0.01）. ConclusionsThe environment in ICU is quite complicated and patients often have the characteristic of instability, which drives us to evaluate the influence factors of CRBSI and offer guidance for PICC maintenance. These can help reduce the incidence of CRBSI in ICU and improve the quality of patients.