肝胆外科PICC导管相关性感染的影响因素分析

Analysis of influencing factors of PICC catheter-related infections in hepatobiliary surgery

目的:探究肝胆外科经外周静脉中心静脉置管(PICC)导管相关性感染的影响因素,并制定相应的防治策略。方法:回顾性分析2020年1月—2023年3月某院肝胆外科接受治疗并留置PICC导管的258例患者的病历资料,依据是否发生PICC导管相关性感染将其分为感染组和未感染组,单因素及多因素Logistic回归分析患者发生PICC导管相关性感染的影响因素,根据影响因素建立预测模型,绘制受试者工作曲线(ROC)评估模型诊断效能。结果:258例患者发生PICC导管相关性感染40例,其中局部感染20例,导管相关血流感染20例;感染患者血液中共培养分离病原菌61株,其中革兰氏阳性菌35株,革兰氏阴性菌23株,真菌3株。单因素分析显示,2组患者间性别、既往手术史、置管季节、有无心血管疾病、穿刺部位、穿刺血管、穿刺方法、导管类型、周期性导管维护、静脉炎史及导管堵塞情况比较差异无统计学意义(P>0.05);感染组年龄≥60岁、有糖尿病史、单次置管穿刺数≥2次、使用双腔导管及导管留置时间≥7 d的比例高于未感染组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄≥60岁、有糖尿病史、单次置管穿刺数≥2次、使用双腔导管及导管留置时间≥7 d为肝胆外科患者发生PICC导管相关性感染的影响因素(P<0.05)。ROC曲线分析显示,该预测模型AUC值为0.865,敏感度为75.00%,特异度为86.70%。结论:肝胆外科PICC导管相关性感染发生率较高,年龄、合并基础疾病、穿刺次数、导管腔数及导管留置时间均是其影响因素,临床应针对上述影响因素进行提前干预予以降低感染发生率,构建预测模型有助于帮助临床筛选PICC导管相关性感染高危人群。

Objective:To explore the influencing factors of catheter-related infections(PICC)in hepatobiliary surgery and to develop corresponding prevention and treatment strategies.Methods:A retrospective analysis was conducted on the data of 258 patients who received treatment and had PICC catheters placed in the hepatobiliary surgery department of a hospital from January 2020 to March 2023.Based on the occurrence of PICC catheter-related infections,they were divided into an infected group and an uninfected group.Univariate and multivariate logistic regression analyses were conducted to identify the influencing factors of PICC catheter-related infections in the patients,and a predictive model was established based on the influencing factors.A receiver operating characteristic(ROC)curve was plotted to evaluate the diagnostic performance of the model.Results:Out of the 258 patients,40 developed PICC catheter-related infections,including 20 local infections and 20 catheter-related bloodstream infections;61 strains of pathogenic bacteria were cultured and isolated from the blood of the infected patients,including 35 strains of Gram positive bacteria,23 strains of Gram negative bacteria,and 3 strains of fungi.Univariate analysis showed that there were no statistically significant differences between the two groups of patients in gender,previous surgical history,catheterization season,presence of cardiovascular disease,puncture site,puncture vessel,puncture method,catheter type,periodic catheter maintenance,history of phlebitis,and catheter blockage(P>0.05).The rates in the infection group of age≥60 years,history of diabetes,more than 2 single catheterization punctures,using double lumen catheters and catheter retention time≥7 days were higher than those of the uninfected group,and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis indicated that the influencing factors of PICC catheter related infection in patients with hepatobiliary surgery were age≥60 years,diabetes,the number of single catheterization punctures≥2,the use of double lumens of catheters and the retention time of catheters≥7 days(P<0.05).ROC curve analysis showed that the AUC value of the prediction model was 0.865,with a sensitivity of 75.00%and a specificity of 86.70%.Conclusion:The incidence of PICC catheter-related infections in hepatobiliary surgery is relatively high.Age,comorbidities,number of punctures,number of catheter cavities,and catheter retention time are all influencing factors.Clinical intervention should be carried out in advance to reduce the incidence of infections based on these influencing factors.Constructing a predictive model can help screen high-risk populations for PICC catheter-related infections in clinical practice.