鼻咽癌放化疗患者PICC导管相关性感染的危险因素分析及护理对策

Analysis of risk factors of PICC catheter-related infection in patients with radiotherapy and chemotherapy of nasopharyngeal carcinoma and nursing strategies

目的分析鼻咽癌放、化疗患者PICC导管相关性感染的危险因素,提出有效干预措施。方法选取2016年1月至2017年2月在医院接受治疗并行PICC导管留置的260例鼻咽癌放、化疗患者的病历资料进行回顾性分析,分析PICC-RI发生的危险因素。分析内容包括:年龄(以60岁为界分组)、性别、留置时间(以3个月为界)、置管季节、单次穿刺次数、置管型号(单腔/双腔)、穿刺部位、导管维护频率(正常/延迟)、白细胞、中性粒细胞、白蛋白等指标,采用SPSS 20.0进行统计分析,筛选感染相关危险因素。结果发生导管相关性感染24例,发生率:9.2%,其中发生导管相关性血流感染4例,发生率:1.5%。留置时间≥3个月、置管季节、导管维护频率、白细胞、中性粒细胞、白蛋白这6方面比较,差异具有统计学意义(P<0.05)。结论鼻咽癌放、化疗患者发生PICC导管相关性感染的危险因素较多:控制留置时间、加强PICC相关知识宣教、实施营养干预手段、提高患者抵抗力可降低发生PICC导管相关性感染的风险。

Objective To analyze the risk factors of PICC catheter-related infection in patients with radiotherapy and chemotherapy of nasopharyngeal carcinoma and to propose effective intervention measures. Methods The medical records of 260 nasopharyngeal carcinoma patients undergoing radiotherapy and chemotherapy were retrospectively analyzed from January 2016 to February 2017 in hospitals treated with parallel PICC catheters to analyze the risk factors of PICC-RI. The analysis included： age （grouped by age 60）, gender, retention time （with 3 months）, catheterization season, number of single punctures, catheter model （single lumen/double chamber）, puncture site, Catheter maintenance frequency （normal/delayed）, white blood cells, neutrophils, albumin and other indicators were analyzed using SPSS20.0 for screening for infection-related risk factors. Results There were 24 cases of catheter-related infection. The incidence rate was 9.2%. There were 4 catheter-related bloodstream infections. The incidence rate was 1.5%. The indwelling time was more than 3 months, the catheterization season, the frequency of catheter maintenance, white blood cells, neutrophils, and albumin. The difference was statistically significant （P〈0.05）. Conclusion There are many risk factors for PICC catheter-related infection in patients with radiotherapy and chemotherapy of nasopharyngeal carcinoma. Controlling indwelling time, enhancing PICC related knowledge, implementing nutritional interventions, and improving patient＇s resistance can reduce the risk of PICC catheter-related infection.