不同消毒方法对神经外科中心静脉导管置管患者导管相关性感染及敷贴粘贴牢固度的影响

Effects of different disinfection methods on catheter-related infection and the reliability of application in patients with central venous catheter in neurosurgery

目的探讨如何降低神经外科中心静脉导管置管患者导管相关性感染率及提高敷贴粘贴牢固度。方法选取神经外科留置中心静脉导管患者480例为研究对象,随机分为5%聚维酮碘组、氯己定醇复方组及5%聚维酮碘+氯己定醇复方组,对3组患者的消毒效果、敷贴粘贴牢固度及皮肤不良反应等进行比较。结果3组在消毒前、后的细菌总数及消毒合格率均无显著差异(P>0.05)。与5%聚维酮碘组相比,5%聚维酮碘+氯己定醇复方组敷贴粘贴牢固率更高(P<0.05),而与氯己定醇复方组相比无显著差异(P>0.05);5%聚维酮碘+氯己定醇复方组导管相关性感染率更低(P<0.05),而与氯己定醇复方组相比无显著差异(P>0.05);5%聚维酮碘+氯己定醇复方组皮肤不良反应发生率更高(P<0.05),而与氯己定醇复方组相比无显著差异(P>0.05)。结论5%聚维酮碘与氯己定醇用于神经外科中心静脉导管置管患者的消毒维护,均能起到良好的消毒效果,但5%聚维酮碘消毒中心静脉导管相关性感染发生率较高,可能与其消毒后敷贴粘贴不牢固发生率较高有关,氯己定醇消毒容易引起皮肤不良反应,值得关注。

Objective To explore how to reduce the catheter-related infection rate and improve the firmness of application in patients with central venous catheter in neurosurgery.Methods A total of 480 patients with neurosurgical indwelling central venous catheter were randomly divided into 5%povidone iodine group,chlorhexidine alcohol compound group and 5%povidone iodine+chlorhexidine alcohol compound group.The disinfection effects,firmness of application and adverse skin reactions of the three groups were compared.Results There were no significant differences in the total number of bacteria before and after disinfection and the qualified rate of disinfection among the three groups(P>0.05).Compared with 5%povidone iodine group,5%povidone iodine+chlorhexidine alcohol compound group had a higher adhesion rate(P<0.05),but there was no significant difference compared with chlorhexidine alcohol compound group(P>0.05).Compared with 5%povidone iodine group,the catheter-related infection rate of 5%povidone iodine+chlorhexidine alcohol compound group was lower(P<0.05),but there was no significant difference compared with chlorhexidine alcohol compound group(P>0.05).Compared with 5%povidoneiodine group,5%povidone-iodine+chlorhexidol compound group had a higher incidence of skin adverse reactions(P<0.05),but there was no significant difference compared with chlorhexidol compound group(P>0.05).Conclusion 5%povidone iodine and chlorhexidine alcohol can play a good disinfection effect in the disinfection and maintenance of neurosurgical central venous catheter patients.However,the use of 5%povidone iodine disinfection has a higher incidence of central venous catheter related infection,which may be related to the high incidence of loose application after 5%povidone iodine disinfection.Chlorhexidine alcohol disinfection is easy to cause adverse skin reactions,which is worthy of attention.