新生儿不同置管方式并发感染风险因素的分析及置管时间对感染的影响

Analysis of risk factors of infection in newborns with different catheterization and the effect of intubation time on infection

目的比较新生儿不同置管方式的中心静脉置管相关的静脉感染（CLABSI）发病率、每种置管方式的新生儿一般状况以及置管时间对CLABSI的影响。方法选择2014年8月至2016年9月植入脐静脉置管（UVC）或PICC的803例重症监护室新生儿。其中278例新生儿行UVC（UVC组），262例新生儿行PICC（PICC组），263例新生儿联合使用UVC及PICC置管（联合组）。观察每组新生儿的一般状况并比较，记录每组新生儿第4天感染CLABSI数，评估置管第10天每组CLABSI的进展情况。结果3组新生儿在孕周、出生体质量、出生时合并呼吸窘迫综合征数量、出生时并发脓毒血症数量、是否为剖宫产婴儿以及婴儿死亡数方面比较差异有统计学意义（F=5．998、4．943，χ2=5．160—8．970，均P〈0．05）。第4天CLABSI的发病率：UVC组1．1％（3／278），PICC组1．9％（5／262），联合组3．O％（8／263）。第10天CLABSI的发病率：UVC组5．4％（15／278），PICC组2．7％（7／262），联合组中已经拔除UVC患者为5．1％（10／196），而未拔除UVC患者为10．4％（7／67）。PICC组和联合组已经拔除UVC患者CLABSI感染率差异无统计学意义（P〉0．05），而UVC组的发病率显著上升，组内比较CLABSI感染率比较差异有统计学意义（χ2=2．85，P〈0．05），联合组在4d内未拔除UVC患者CLABSI感染率显著上升，组内比较CLABSI感染率差异有统计学意义（χ2=6．31，P〈0．01）。结论UVC置管感染CLABSI的潜在风险较PICC大，如果短期置管可选用UVC，而长期置管需选用PICC。

Objective To study comparison of central line-associated bloodstream infection （CLABSI） with different catheterization methods of neonates and the comparison of each type of catheter and the general condition of neonates and the influence of catheter time on CLABSI. Methods A total of 797 neonates with umbilical venous catheter （UVC） or PICC were studied from August 2014 to September 2016,among them, 278 were adopted with UVC （UVC group）,262 were adopted with PICC （PICC group）, and 263 were adopted with UVC and PICC catheter （combination group）.Respectively recorded all the neonates＇ general situation, analized the differences of each group, and recorded each group of 4 days of CLABSI number, and evaluated the lOth day of CLABI progress of each group. Results There were significant differences among 3 groups of newborns in gestational weeks, birth weight, the number of respiratory distress syndrome at birth, the number of sepsis at birth, the number of cesarean delivery babies and the number of deaths were statistically significant （F=5.998, 4.943, χ2=5A60-8.970, all P 〈 0.05）. The incidence of CABSI in fourth days was 1.1% （3/278） in UVC group, 1.9% （5/262） in PICC group, and 3.0%（8/263） in combination group. On the tenth day, the incidence of CABSI was 5.4% （15/ 278） in UVC group, 2.7% （7/262） in PICC group, and 5.1% （10/196） in combination group removing UVC, while 10.4% （7/67） in combination group without removing UVC. The PICC group and the combination group removing UVC had no significant difference in CABSI infection （P 〉 0.05） and in UVC group, the incidence rate increased significantly （χ2=2.85, P 〈 0.05）, combination group without removing UVC increased significantly in patients with CABSI infection and the difference was statistically significant （χ2= 6.31, P 〈 0.01）. Conclusions UVC group had more risk of CABSI compared with PICC, we can choose UVC for short term, and PICC catheter for long term.