超声引导中长导管置入可降低导管相关血流感染发生率

Ultrasound-guided placement of midline catheter reduces the incidence rate of catheter-related bloodstream infection

目的探讨超声引导置入中长导管对急诊重症患者导管相关血流感染(CRBSI)发生率的影响。方法选取2018年3月至2019年12月急诊重症医学科收治529例患者为研究对象,按是否开展超声引导中长导管(MC)置入技术分为MC组(n=278)和对照组(n=251),MC组应用超声引导置入MC作为早期拔除中心静脉导管(CVC)的序贯方法,对照组采用留置针作为CVC拔除后的静脉序贯治疗方法。统计CVC、MC、留置针留置时间,比较两组CVC使用率,绘制Kaplan-Meier生存曲线描述两组的CVC留置时间并进行Log-rank检验,Cox回归分析CVC留置时间的影响因素,比较CRBSI和其他导管相关并发症发生率。结果MC组CVC留置时间显著短于对照组(8 d vs.13 d,P=0.000),CVC使用率显著低于对照组(49.83%vs.80.45%,P=0.000);Cox回归分析显示困难静脉、ICU住院时间延长、置管部位和未开展超声引导MC置入均是CVC留置时间延长的独立危险因素(P=0.000);MC组CRBSI发生率显著低于对照组(0.571‰vs.3.802‰,P=0.038),两组其他导管相关并发症发生率差异无统计学意义(P=0.403)。结论开展超声引导置入MC可缩短CVC留置时间,减少CVC使用率,降低CRBSI发生率,值得临床推广。

Objective To investigate the effect of ultrasound-guided midline catheter placement on the incidence of catheter-related bloodstream infection(CRBSI)in severe emergency patients.Methods Five hundred and twenty-nine patients were chosen as the research objects from March 2018 to December 2019 at Emergency Intensive Care Unit,which was divided into the experimental group(n=278)and the control group(n=251).In the experimental group,ultrasound-guided midline catheter was used as central venous catheter(CVC)removal method of sequential,and in the control group,peripheral venous indwelling needle was used as sequential method after removal of CVC.CVC,midline catheter and the indwelling time of indwelling needle were counted.The utilization rate of CVC was compared between the two groups.Kaplan-Meier survival curve was plotted to describe the CVC indwelling time of the two groups and log-rank test was performed.Cox regression analysis was performed to analyze the influencing factors of CVC indwelling time and compare the incidence of CRBSI and other catheter-related complications.Results The CVC indwelling time of the experimental group was significantly shorter than that of the control group(8 d vs.13 d,P=0.000).The CVC utilization rate of the experimental group was significantly lower than that of the control group(49.83%vs.80.45%,P=0.000).Multivariate Cox regression analysis showed that difficult intravenous access,length of ICU stay,the site of catheter placement,and midline catheter implantation without ultrasound-guidance were independent risk factors for prolonged CVC indwelling time(P=0.000).The CRBSI rate of the experimental group was significantly lower than that of the control group(0.571‰vs.3.802‰,P=0.038).There was no significant difference in the incidence of other catheter-related complications between the two groups(P=0.403).Conclusions Ultrasound-guided midline catheter implantation can shorten the indwelling time of CVC,reduce the utilization rate of CVC,and reduce the incidence of CRBSI,which is worthy of clinical promotion.