中心静脉导管抗生素封管的适应证和禁忌证

Indications and contra-indications of antibiotic lock technique in central venous catheter

目的 :探讨中心静脉导管抗生素封管的适应证和禁忌证。 方法 :5 0例中心静脉置管期间出现畏寒和发热病人 ,用含头孢他啶 0 .5g的肝素等渗盐水 5ml作中心静脉导管暂时封管 ,进行前瞻性调查研究。 结果 :5 0例病人被证实为中心静脉导管相关性感染者有 2 9例 ,其中 5例给予拔管处理。 2 4例给予抗生素封管治疗 ,其中 13例有效 ,11例无效。 结论 :中心静脉导管抗生素封管的适应证为 :①中心静脉插管期间出现畏寒和发热 ,在寻找感染源期间 ,可暂时给予抗生素封管 ;②晚期肿瘤病人 ,因长期外周静脉输液及给药困难 ,而放置中心静脉导管者 ;③需较长时期 (>1个月 )PN支持 ,且病情稳定的住院病人 ;④家庭肠外营养者。禁忌证为 :①病人一般情况较差 ,病情不稳定者 ;②因术中监护需要而放置的中心静脉导管 ,术后用于短期输液、给药或肠外营养者 ;③较严重的免疫功能低下病人 ;④封管期间病情加重或封管 4

Objectives:To study indications and contra indications of antibiotic lock technique in central venous catheter. Methods:Fifty patients with sepsis during use of central venous catheter were studied prospectively.The drug of ceftazidine(0.5 g) was instilled into the central line as a transient “lock”, together with mixed solution(5 ml) of normal saline and heparin sodium. Results:Twenty nine cases were proved to be catheter related sepsis.5 cases were treated by removal of infected catheter.Twenty four cases were treated by antibiotic lock technique.Out of 24,only 13 cases wee successful. Conclusions:Indications of antibiotic lock technique are as follows:① transient use when looking for source of infection, ② in patients with late stage tumor, ③inpatients with steady state of illness and ④patients receiving home parenteral nutrition.The contra indications include:①inpatients in unsteady state of illness,②for short term transfusion or parenteral nutrition, ③patients with compromised immune responsiveness,and ④with deteriorated state of an illness or the infections not controlled.