心脏术后中心静脉导管相关性感染的分析及护理

Complications and risk factors to central venous catheter-related blood stream infection in patients undergone cardiac surgery

目的分析心脏术后中心静脉导管相关性感染(central venous catheter-related blood stream infection,CRBSI)的危险因素,并提出护理措施。方法回顾分析本院2015年1月~2016年12月2 065例留置中心静脉导管(central venous catheter,CVC)的心脏术后患者,引入患者年龄段、心脏功能、患者营养状况、体外循环时间、CVC置管位置、CVC留置时间、穿刺点局部皮肤变化(如:皮炎、多汗等)作为观察因素;应用二分类Logistic回归分析探索影响CRBSI的危险因素。结果纳入观察的2 065例患者出现CRBSI共46例(2.23%),死亡2例(4.35%)。Logistic回归分析显示CVC穿刺点局部皮肤改变和留置时间为增加CRBSI的危险因素。结论 CVC留置时间增加CRBSI的发生率,而穿刺点局部皮肤炎性改变增加细菌沿导管与皮下隧道间隙进入血管内的机会,也提高CRBSI的发生率。对于穿刺点局部皮肤的细心观察及护理,可能降低CRBSI的发生率。

Objective Analysis the risk factors to the central venous catheter-related blood stream infection(CRBSI)on the patients undergone cardiac surgery,and put forward the nursing measures to the patient with the risk of factors.Methods Retrospective analysis of 2 065 cases postoperative patients with central venous catheter(CVC)from January 2015 to December 2016,analysis the correlation of patients'age,cardiac function,nutriture,cardiopulmonary bypass time,the CVC indwelling time,the site of CVC insertion,and local skin changes of puncture point to CRBSI in patients under heart surgery.To explore the risk factors to CRBSI by the binary classification Logistic regression analysis.Results In 2 065 patients,46 cases(2.23%)were diagnosed with CRBSI before discharge,and 2 cases(4.35%)died of CRBSI.Logistic regression analysis determined the CVC indwelling time and local skin changes of puncture point increasing the risk factors of CRBSI.Conclusion Central venous catheter indwelling time and local skin changes of puncture point increased CRBSI.The inflammatory changes of local skin in puncture point increased the risk of bacteria invasion along the subcutaneous tunnel,the observation and nursing to the local skin of puncture point may reduce the risk of CRBSI.