葡萄糖酸氯己定抗菌敷料联合氯己定擦浴在预防股静脉血滤导管相关血流感染中的效果研究

Effectiveness of chlorhexidine gluconate gel dressings combined with chlorhexidine wipe bath on femoral venous central line-associated bloodstream infections in continue renal replacement therapy

目的研究葡萄糖酸氯己定抗菌敷料联合氯己定沐浴消毒湿纸巾全身擦浴对股静脉血滤导管相关血流感染（CLABSI）的预防效果。方法选取南京大学医学院附属鼓楼医院重症医学科2016年1月至2017年11月留置股静脉血滤导管并行CRRT治疗的593例患者为研究对象，其中2016年1-12月纳入的282例患者为对照组，采用3M透明敷料和温水全身擦浴；2017年1-11月纳入的311例患者为试验组，采用3M葡萄糖酸氯己定抗菌敷料联合2%氯己定沐浴消毒湿纸巾全身擦浴，比较2组患者血滤导管CLABSI发生例数、发病率及发生时间。结果试验组患者发生CLABSI 4例，对照组发生12例，差异有统计学意义（χ^2=3.900，P〈0.05）。试验组总的导管日为3 219 d，发病率为1.2‰（4/3 219）；对照组总的导管日为2 249 d，发病率为5.3‰（12/2 249）。试验组发生CLABSI的时间为（12.50 ± 8.23）d，对照组为（10.50 ± 6.46）d，差异无统计学意义（t=0.504，P〉0.05）。结论葡萄糖酸氯己定抗菌敷料联合氯己定擦浴可有效降低股静脉血滤导管CLABSI的发生。

ObjectiveTo investigate the prevention effect of chlorhexidine gluconate （CHG） gel dressings combined with chlorhexidine wipe bath on femoral venous central line-associated bloodstream infections （CLABSI） in continue renal replacement therapy （CRRT）.MethodsA total of 593 cases of patients with femoral venous catheter who receipted CRRT were divided into the experimental group and the control group. 282 cases of patients who hospitalized in ICU from January 2016 to December 2016 were assigned into the control group and received 3M transparent dressings and whole-body warm water bathing.Those hospitalized in ICU from January 2017 to November 2017 were assigned into the experimental group including 311cases and received 3M CHG gel dressingscombined with 2% chlorhexidine wipe bathing. Incidence of CLABSI were compared between the two groups.Results4 cases of patients occurred CLABSI in the experimental group and 12 cases occurred CLABSI in the control group, the difference between groups was statistically significant（χ^2=3.900, P〈0.05）. In the experimental group, 311 cases were retained for 3219 catheter-days, and 282 cases in the control group were retained for 2 249 catheter-days. Compared with transparent dressings and whole-body warm water bathing, chlorhexidine gluconate gel decreasescombined with 2% chlorhexidine wipe bath could reduce the morbidity of CLABSIs from 5.3‰（12/2 249） to 1.2‰（4/3 219）. The on onsite time of CLABSI in the experimental group was （12.5±8.23） days, which in the control group was （10.50±6.46） days, the differenceare not statistically significant （t=0.504, P〉0.05） .ConclusionsCHG gel dressings combined with chlorhexidine wipe bathing would be more effective to prevent CLABSI in CRRT.