不同封管方式与带cuff的中心静脉导管失功能及感染的相关性分析

Correlation analysis between different sealing methods and incapacity and infection of central venous catheter with cuff

目的分析单纯肝素盐水封管与肝素联合抗生素封管对带cuff的中心静脉导管失功能、感染的影响。方法选取眉山市彭山区人民医院血液透析科2015年1月至2017年3月收治的92例置入带cuff的中心静脉导管的血液透析患者,按照随机数字表法平均分为实验组和对照组,实验组给予45 mg/ml肝素钠+10 mg/ml头孢呋辛钠封管,对照组单纯给予45 mg/ml肝素盐水封管;比较两组患者导管感染率、病原菌分布、其他并发症发生率及导管使用寿命;应用Kaplan-Meier法绘制导管使用曲线;采用COX回归方程分析影响导管使用时间的危险因素。结果 (1)实验组与对照组导管感染率分别为2. 17%与17. 39%,差异有统计学意义(χ~2=4. 434,P=0. 035);(2)导管相关性感染病原菌分布前三位的依次是金黄色葡萄球菌(40. 0%)、链球菌(30. 0%)、肠球菌属(20. 0%);(3)血红蛋白水平和感染是影响导管使用时间的独立危险因素(P <0. 05),抗生素封管是保护因素(P <0. 05);(4)实验组与对照组感染以外并发症发生率分别为10. 86%(5/46)与为30. 43%(14/46),两组比较差异有统计学意义(χ~2=5. 373,P=0. 020);实验组和对照组的导管中位使用时间分别为58(13~72)周和52(9~70)周,实验组的导管失功能发生风险明显低于对照组(HR=0. 395,95%CI0. 172~0. 965,P=0. 048)。结论应用抗生素与肝素钠联合封管可降低中心静脉导管感染率,减少并发症,延长使用寿命,值得临床推广。

Objective To analyze the effect of tube-sealing method of single heparin saline or heparin saline plus antibiotics on the incapacity and infection of central venous catheter with cuff.Methods 92 hemodialysis patients were selected,who were treated by the central venous catheter with cuff in the Department of Hemodialysis of Pengshan District People’s Hospital from January 2015 to March 2017.The patients were randomly divided into an experimental group and a control group according to the random number table method.The experimental group was given 45 mg/ml heparin saline plus 10 mg/ml cefuroxime sodium while the control group was given 45 mg/ml heparin saline,for tube sealing.The two groups were compared in catheter infection rate,pathogen distribution,incidence of other complications,and catheter life.The Kaplan-Meier method was used to draw the catheter application curve,and the COX regression equation was used to analyze risk factors affecting use time of the catheter.Results(1)The catheter infection rate was 2.17%in the experimental group and 17.39%in the control group,the difference of which was statistically significant(χ~2=4.434,P=0.035).(2)Staphylococcus aureus(40.00%),streptococcus(30.00%),and enterococci(20.00%)were the most common pathogens in the catheterrelated infections.(3)Hemoglobin level and infection were the independent risk factors for the catheter survival,and the tube-sealing with antibiotics was an independent protective factor(P<0.05).(4)The incidence of complications other than infection was 10.86%(5/46)in the experimental group and 30.43%(14/46)in the control group,the difference of which was statistically significant(χ~2=5.373,P=0.020).The median survival time of catheter was 52(9 to 70)weeks and 58(13 to 72)weeks in the control and experimental groups,respectively.The risk of catheter failure in the experimental group was significantly lower than that in the control group(HR=0.395,95%CI 0.172-0.965,P=0.048).Conclusion The tube-sealing method of heparin saline plus antibiotics could reduce the central venous catheter infection rate,reduce complications,and prolong the catheter survival,which is worthy of clinical promotion.