葡萄糖酸氯己定抗菌敷料在血液透析长期导管中的应用

Application of antibacterial dressing containing chlorhexidine gluconate for long-term hemodialysis catheters

目的探讨葡萄糖酸氯己定抗菌透明敷料在维持性血液透析长期导管维护中的作用。方法本研究为单中心前瞻性队列研究,纳入符合标准的长期导管患者56例按随机数字表法分为观察组和对照组各28例,观察组在长期导管出口处采用葡萄糖酸氯己定抗菌透明敷料,每周更换1次;对照组则使用传统的无菌纱布敷料,每周更换3次。2组每次导管护理和上下机操作均一致,并测量记录长期导管外露的长度。观察2组患者的导管相关性感染率和导管滑脱率,观察期为12个月。结果Kaplan-Meier生存曲线提示,抗菌敷料组的导管相关性感染率与对照组无统计学差异(Log-rank检验:P=0.078),抗菌敷料组的导管滑脱率要低于对照组(Log-rank检验:P=0.040)。结论葡萄糖酸氯己定抗菌透明敷料能有效降低血液透析患者导管滑脱率,但2组患者的导管相关性感染率无显著差异。

Objective To investigate the effect of antimicrobial transparent dressing containing chlorhexidine gluconate on the maintenance of long-term hemodialysis catheters.Methods This was a single-center prospective cohort study enrolling 56 patients with long-term catheters.The patients in the observation group were treated with antimicrobial transparent dressing containing chlorhexidine gluconate at the outlet of longterm catheters,and the dressing was replaced once a week.The patients in the control group were given traditional sterile gauze dressing,which was changed three times a week.The length of long-term catheter outside of the outlet was measured and recorded.The rates of catheter-related infection and catheter slippage in the two groups were observed for 12 months.Results Kaplan-Meier survival curve showed that there was no significant difference in catheter-related infection rate between the two groups(log-rank test,P=0.078).The catheter slippage rate was lower in the observation group than in the control group(log-rank test,P=0.040).Conclusion Antimicrobial transparent dressing containing chlorhexidine gluconate can effectively reduce the catheter slippage rate in hemodialysis patients.However,there is no significant difference in catheter-related infection rate between the two groups.