消化道肿瘤患者植入式静脉输液港导管相关性血流感染的影响因素

Influencing factors for implantable intravenous infusion port-catheter-related bloodstream infection in patients with gastrointestinal tumors

目的研究探讨消化道肿瘤患者植入式静脉输液港(IVAP)导管相关性血流感染(CRBSI)的发生率及其影响因素。方法选取187例2016年3月-2017年5月在河南大学人民医院住院治疗并且接受IVAP置管的经组织病理确诊的消化道肿瘤患者进行前瞻性研究。记录所有患者的临床资料,随访一年,观察所有患者发生CRBSI的情况;分析患者临床资料与CRBSI之间的关系。再进一步采用Logistic回归模型分析引起CRBSI的影响因素。结果随访1年,187例患者中,发生CRBSI(11.23%)的有21例;单因素分析结果表明:CRBSI的发生与卡氏评分(KPS)、胰腺癌、食管癌、导管感染史、胃肠外营养支持(PN)例数及每月导管留置时间有关(均P<0.05);进一步Logistic分析结果表明:每月导管留置时间及PN均是影响消化道肿瘤患者发生CRBSI的独立影响因素,KPS评分则为引发CRBSI的保护因素(均P<0.05)。结论每月导管留置时间和PN是胃肠道肿瘤患者发生CRBSI的独立危险因素,KPS评分是保护因素,将IVAP植入消化道肿瘤患者体内后,可监测上述指标,降低CRBSI的发生概率。

OBJECTIVE To explore the incidence of implantable intravenous infusion port-catheter-related bloodstream infection(BSI)in patients with gastrointestinal tumors and analyze the influencing factors.METHODS A total of 187 patients who were hospitalized in Henan Province People’s Hospital treated with IVAP and diagnosed with gastrointestinal tumors by histopathologic examination from Mar.2016 to May 2017 were enrolled in the study,the prospective study was performed.The clinical data of all the patients were recorded,a 1-year follow-up was conducted,the incidence of BSI was observed,the correlation between the clinical data and the BSI was analyzed,and the logistic regression model analysis was performed for the influencing factors for the catheter-related bloodstream infection.RESULTS The 1-year follow-up showed that 21(11.23%)of 187 patients had CRBSI.The univariate analysis indicated that the incidence of CRBSI was associated with Karnofsky Performance Status(KPS),pancreatic cancer,esophageal cancer,history of ductal infection,parenteral nutrition(PN)and monthly catheter indwelling time(all P<0.05).The logistic regression analysis showed that the monthly catheter indwelling time and PN were the independent influencing factors for the CRBSI in the patients with gastrointestinal tumors,while the KPS was the protective factor for the CRBSI(all P<0.05).CONCLUSION The monthly catheter indwelling time and PN are the independent risk factors for CRBSI in the patients with gastrointestinal tumors,KPS is a protective factor,and it is necessary to monitor the above indexes for the gastrointestinal tumor patients who were treated with IVAP so as to reduce the incidence of CRBSI.