危重症患儿中心静脉导管堵塞危险因素分析

Risk factors analysis of central venous catheter occlusion in critically ill children

目的了解危重症患儿中心静脉导管(Central venous catheter,CVC)堵塞发生率并分析影响因素,为改进导管护理方案提供依据。方法采用回顾性队列研究设计,选取2020年1-8月我院儿童重症监护室(Pediatric intensive care unit,PICU)收治的328例中心静脉置管患儿为研究对象,采用自制问卷收集相关资料,统计并分析患者发生堵管的现状及危险因素。结果60例患儿发生中心静脉导管堵塞,发生率为18.3%,Logistic回归分析结果显示,患儿使用镇静镇痛药物[OR(95%CI)=5.393(1.064~27.337)]、APTT低于正常值[OR(95%CI)=4.964(1.939~12.710)]、使用甘露醇[OR(95%CI)=2.433(1.128~5.249)]是其CVC堵塞的独立危险因素,微量泵泵速≥10 mL/h[OR(95%CI)=0.121(0.027~0.551)]是其保护因素。结论为预防危重症患儿发生中心静脉导管堵塞,护理人员应充分评估、识别高危人群,并适应性调整导管护理策略。

Objective To explore the incidence and risk factors for catheter obstruction in critically ill children with central venous catheters,and to provide basis for the improvement of catheter nursing plan.Methods By retrospective cohort study design,328 patients with central venous catheter admitted to the intensive care unit in a tertiary specialist children's hospital during January 2020 to August were enrolled.The self-made questionnaire was used to collect data regarding potential risk factors.The incidence of and risk factors for the central venous catheter obstruction were analyzed.Results Overall,18.3%of children developed central venous catheter obstruction.The use of sedative and analgesic drugs[OR(95%CI)=5.393(1.064~27.337)],low level of APTT[OR(95%CI)=4.964(1.939~12.710)],the use of mannitol[OR(95%CI)=2.433(1.128~5.249)]were independent risk factors for obstruction in multivariate analysis,while the micro pump speed more than 10 mL/h was a protective factor[OR(95%CI)=0.121(0.027~0.551)].Conclusion During the nursing procedure,we should evaluate the patient comprehensively and identify high-risk groups,to adjust catheter care plan individually.This may help to reduce the incidence of obstruction.