标准集束化中心静脉置管干预策略对置管操作时间及CRBSI的影响分析

Effects analysis of the standard cluster intervention strategy of central venous catheterization on catheterization operation time and CRBSI

目的探讨标准集束化中心静脉置管干预策略对置管操作时间及导管相关性血流感染(CRBSI)的影响。方法回顾性分析3271例进行中心静脉置管患者的相关资料,其中前期(2016年5月~2018年3月)患者(1467例)未遵循标准集束化中心静脉置管干预策略,后期(2018年4月~2020年4月)患者(1804例)遵循标准集束化中心静脉置管干预策略。对比前后期患者一般资料、前后期不同置管部位的置管操作时间、前后期不同置管操作时间CRBSI发生率。结果前期和后期患者性别、年龄、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、置管方位、置管部位及血滤导管用途对比,差异无统计学意义(P>0.05)。后期患者置管操作时间(12.3±3.1)min、导管留置时间(6.4±1.7)d明显短于前期患者的(16.2±3.2)min、(7.1±1.4)d,差异有统计学意义(P<0.05)。后期颈内静脉、股静脉置管患者的置管操作时间短于前期,差异有统计学意义(P<0.05)。前后期锁骨下静脉置管患者置管操作时间对比差异无统计学意义(P>0.05)。前期置管后CRBSI的发生率为2.16/1000导管日,而后期下降为1.95/1000导管日,比较差异有统计学意义(P<0.05)。而随着置管操作时间的延长,前后期的CRBSI发生率也会显著提高;同时置管操作时间越长的患者,前后期CRBSI的发生率也越高。前期置管操作时间>17 min的患者,CRBSI发生率也会明显上升。结论在中心静脉置管过程中应用取得广泛共识的标准集束化干预策略可以在一定程度上缩短置管操作时间,并且达到减少CRBSI发生风险的目的。

Objective To investigate the effects of the standard cluster intervention strategy of central venous catheterization on catheterization operation time and catheter-related bloodstream infection(CRBSI).Methods The relevant data of 3271 patients received central venous catheterization were reviewed,wherein 1467 patients in the early stage(May 2016-March 2018)did not follow the standard cluster intervention strategy of central venous catheterization,and 1804 patients in the late stage(April 2018-April 2020)followed the standard cluster intervention strategy of central venous catheterization.The general data of patients,catheterization operation time at different catheterization sites,and the incidence of CRBSI for different catheterization operation time were compared between the early and late stages.Results The differences in gender,age,acute physiology and chronic health evaluation scoring systemⅡ(APACHEⅡ),catheterization orientation,catheterization sites and use of hemofiltration catheter of the patients between the early and late stages were not statistically significant(P>0.05).The patients in the late stage had catheterization operation time of(12.3±3.1)min and catheter indwelling time of(6.4±1.7)d,which were significantly shorter than(16.2±3.2)min and(7.1±1.4)d of the patients in the early stage,and the differences were statistically significant(P<0.05).The catheterization operation time at internal jugular vein and femoral vein of the patients in the late stage were shorter than those of the patients in early stage,and the differences were statistically significant(P<0.05).The difference in catheterization operation time at subclavian vein of the patients between the early and late stage was not statistically significant.The incidence of CRBSI after catheterization for the patients in the early stage was 2.16/1000 catheter days,while it was 1.95/1000 catheter days in the late stage,and the difference was statistically significant.As the catheterization operation time increased,the incidence of CRBSI also increased significantly for the patients in both of the early and late stages.The longer the catheterization operation time,the higher the incidence of CRBSI for the patients in both of the early and late stages.In the early stage,the incidence of CRBSI also increased significantly for the patients with the catheterization operation time>17 min.Conclusion The application of widely-accepted standard cluster intervention strategy in the central venous catheterization can reduce the catheterization operation time in a certain degree,so the objective of reducing the incidence of CRBSI is achieved.