尿激酶封管时间对中心静脉导管相关性血流感染影响

EFFECT OF DURATION OF CATHETER LOCK USING UROKINASE ON CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTION

目的探讨尿激酶封管时间对中心静脉导管相关性血流感染的影响。方法收集2016年10月—2017年8月我院ICU内留置右侧颈内静脉导管病人75例,随机分为对照组(A组)、尿激酶封管30 min组(B组)和尿激酶封管60min组(C组),每组25例。B、C组病人每周换药前将2.5×107 U/L浓度的尿激酶于主端注入0.6mL、副端注入0.4mL,分别暂时封闭管路30min和60min;A组病人使用生理盐水封管。比较各组中心静脉导管相关性血流感染率及封管前后凝血指标。结果与A组相比,B、C组病人中心静脉导管相关性血流感染率较低,差异有统计学意义(χ2=5.75、6.35,P<0.05);B组与C组比较差异无统计学意义(P>0.05)。各组病人封管前后各凝血指标比较差异无统计学意义(P>0.05)。结论尿激酶封管30 min可有效预防中心静脉导管相关性血流感染,且对病人凝血指标无影响,安全有效。

Objective To investigate the effect of duration of catheter lock using urokinase on central venous catheter-related bloodstream infection. Methods A total of 75 patients who were treated using a right jugular vein indwelling catheter in the Intensive Care Unit of our hospital from October 2016 to August 2017 were enrolled in the study.These subjects were randomly and equally divided into control group（group A）,30 min catheter lock group（group B）,and 60 min catheter lock group（group C）.Before dressing change every week,the patients in groups B and C were given 0.6 mL urokinase（2.5×107 U/L）injected at the main end of the catheter and 0.4 mL of the urokinase injected at the sub end of the catheter and then had the catheters locked for30 min and 60 min,respectively.The catheters were locked using normal saline in the control group.These groups were compared in terms of the rate of central venous catheter-related bloodstream infection and coagulation markers before and after catheter lock.Results Compared with group A,groups B and C had a significantly lower rate of central venous catheter-related bloodstream infection（χ2=5.75 and 6.35,P〈0.05）;there was no significant difference in this rate between group B and group C（P〈0.05）.There were no significant differences in coagulation markers before and after catheter lock between these groups（P〈0.05）.Conclusion Central venous catheter-related bloodstream infection can be effectively prevented by locking the right jugular vein catheter using urokinase for 30 min,which is a safe and effective means without affecting the coagulation markers of patients.