Clinical analysis of central venous catheter-related infections in patients in the emergency ICU

BACKGROUND:Catheter-related infection(CRI)of the central vein is a common cause of nosocomial infection.This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit(EICU)in order to provide the beneficial reference.METHODS:From January 2008 to December 2010,a total of 1 363 patients were subjected to catheterization.In these patients,the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1 363 patients using the central venous catheter.The peak rate of CRI was 10.79%,with an incidence of 3.05 episodes per 1 000 catheter days.Of the147 patients,46.94%had gram-negative bacilli,40.14%had gram-positive cocci,and 12.92%had fungi.Unconditional logistic regression analysis suggests that multiple catheterization,femoral vein catheterization,the application of multicavity catheter,and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.

Prevention of peripherally inserted central catheter-related infections in very low-birthweight infants by using a central line bundle guideline with a standard checklist

Objective:To investigate the effectiveness and feasibility of using a central line bundle(CLB)guideline with a standard checklist in the prevention of peripherally inserted central catheter(PICC)-related infections(CRIs)in very low-birth-weight infants(VLBWIs).Methods:Fifty-seven VLBWIs who underwent PICC insertion at a hospital in Qingdao,China,between November 2012 and June 2013,were monitored with the CLB guideline and a standard checklist.Fifty-three VLBWIs who underwent PICC insertion were monitored by standard hospital procedures.The incidence of CRIs was compared between the two groups.Results:The incidence of infection significantly decreased from 10.0%catheter days in the control group to 2.2%catheter days in the study group(p<0.05).The indwelling catheter time significantly increased in the study group compared to the control group(31.9±15.0days vs.24.8±7.4 days,respectively,p<0.05).Colonization infections also decreased from 6.9% catheter days in the control group to 2.2%catheter days in the study group(p<0.05).The incidence of catheter-related bloodstream infections decreased from 3.1%catheter days in the control group to 0%catheter days in the study group.Conclusion:The use of a CLB guideline with a standard checklist could be an effective and feasible protocol for preventing CRIs and prolonging indwelling catheter timein VLBWIs.

Ethanol Lock Therapy as additional treatment of catheter-related bloodstream infections in pediatric patients receiving home parenteral nutrition

Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new prophylactic and treatment options have been evaluated to reduce the incidence of CRIs and infection related catheter removals. In children, two retrospective studies have shown the efficacy of ethanol lock treatment (ELT) in reducing the incidence of CRIs in pediatric oncology patients. However, prospective data are missing. Our aim of the present study was to evaluate prospectively the effect of ELT on the cure and recurrence rate of CRIs, duration of hospitalization and antibiotic use in HPN pediatric patients. Methods: HPN children older than three months with a clinical suspicion of a CRI were included and randomised to ELT or standard flushing treatment (heparin or taurolidine). The primary outcomes were persistence and recurrence of the bacteraemia and Central Venous Access Device (CVAD) removal. Secondary outcomes included duration of antibiotic use, duration of hospitalization and side effects. Results: Data from eight HPN children experiencing 14 suspected CRI were analysed. Seven patients had proven CRIs by positive blood cultures. Four were treated with ELT and three with their standard flushing treatment. One CRI persisted in the control group. In one single patient, bacteraemia recurred three times within 24 weeks. This patient had been enrolled in both study arms. A CVAD removal was needed in one patient because of occlusion. Conclusions: This small study showed no additional efficacy of the use of ELT on cure rate or recurrences of CRIs compared to standard therapy in HPN treated children. There were also no differences in duration of hospitalization, the use of antibiotics or CVAD removal between both groups.

Analysis of the relationship between deep venous catheter-related infection and post-operative complications in patients receiving minimally invasive esophagectomy

Objective The aim of the study was to evaluate catheter-related infection rate(CRIR)for patients receiving minimally invasive esophagectomy(MIE),to identify the optimal catheterization approach and relationship between CRIR and post-operative complications.Methods In total,168 patients with esophageal carcinoma and undergoing MIE combined with preoperative deep venous catheterization(DVC)were analyzed in our institution(Qingdao Municipal Hospital,China),from 2014 to 2018.After completing DVC,catheter-tips together with intraductal venous blood samples were sent to the microbiology lab for bacterial strain culture.CRIR was statistically evaluated for the following clinical variables:gender,age,smoking status,drinking status,past history,tumor location,histologic grade,pathological T,N,and M category,anastomotic location,anastomotic leakage,anastomotic stricture,chylothorax,pneumonia,recurrent laryngeal nerve(RLN)injury,reflux esophagitis,catheterization site,and catheter-locking days.Results Among the 144 patients recruited in our study,105 catheters were inserted into the jugular vein and 39 catheters into the subclavian vein.The median age of these patients was 63 years(range:42–79 years),and the median catheter-locking period was seven days(range:4–21 days).Four catheters were identified with three types of strain colonizations,including Staphylococcus epidermidis,Staphylococcus aureus and Blastomyces albicans.Statistical data showed that patients diagnosed with catheter-related infection were likely to incur anastomotic leakage(66.67%,P<0.001)and pneumonia(27.27%,P<0.001);features such as tumors located in the upper esophagus(13.6%,P=0.003),and over seven catheterlocking days(10.00%,P<0.001)were attributed to a high CRIR.Conclusion Although both jugular and subclavian veins can be catheterized for patients with MIE,DVC is associated with more than seven catheter-locking days and upper esophagectomy,due to high CRIR.Furthermore,catheter-related infection is related to anastomotic leakage and pneumonia.

Study progress on relevant infection in central venous catheter led by parenteral nutrition of patients with tumor

With the wide application of parental nutrition(PN) and central venous catheter(CVC) to tumor patients, the relative infection led by CVC has become a common and troublesome hospital infection in clinics. During infusion, PN fluid forms a high-sugar and high-fat micro-environment around CVC, facilitating the adhesion, growth, and diffusion of pathogenic bacteria. This condition forms a bacterial biofilm(BF) consisting of one or several kinds of pathogenic bacteria. Upon formation of the film, pathogens in the BF can resist anti-bacterial drugs and immune cells, causing repeated infections of bacteria or fungi and endangering the lives of patients. In this paper, we summarize the applications of PN, characteristics of CVC infection in tumor patients, mixed BF, and related research methods to provide reference for studies of mixed BF infection of CVC.

Analysis of Use and Outcomes of Peripherally Inserted Central Catheter (PICC-Line) in Hemato-Oncological Patients

Aims: To audit the use and outcomes of using PICC lines in hemato-oncological patients. Objectives: To study the demographics of patients: ?studying the use of PICC line in hemato-oncological patients;studying the rate of complications in PICC line;studying the cause of early removal of PICC line. Methods: All PICCs inserted in adult hemato-oncological patients in Hematology and Medical Oncology Department of Health Care Global (HCG) Hospital were studied prospectively, as per the proforma, till PICCs were removed or patient expired and the pattern of complications were noted. Results: Eighty-four PICCs were inserted over a period of initial nine months and followed for a total of 1 year with three months post insertion duration for a total of 10,868 catheter-days (mean of 129 days i.e. 4.3 months, range: 1 to 288 days). The most common indication for PICC was chemotherapy (100%). Among them 19 (22%) PICCs had complications and 12 were removed at the rate of 1.1/1000 PICC-days. Complications with haematologic malignancies were more as compared to those with solid tissue malignancies. Conclusions: Despite significant complication rates, PICCs are a relatively safe and cost effective mode of establishing central venous access.

Prevention of catheter-related Pseudomonas aeruginosa infection by levofloxacin-impregnated catheters in vitro and in vivo

Background Implanted medical catheter-related infections are increasing,hence a need for developing catheter polymers bonded to antimicrobials.We evaluated preventive effects of levofloxacin-impregnated catheters in catheterrelated Psuedomonas aeruginosa （strain PAO1） infection.Methods Drug release from levofloxacin-impregnated catheters was measured in vitro.Levofloxacin-impregnated catheters and polyvinyl chloride （PVC） catheters were immersed in 5 ml 50％ Luria Bertani medium containing 108 CFU/ml Pseudomonas aeruginosa then incubated for 6,12,24 or 48 hours at 37℃ when bacteria adhering to the catheters and bacteria in the growth culture medium were determined.Impregnated and PVC catheters were singly implanted subcutaneously in mice,50 μl （107CFU） of PAO1 was injected into catheters.After the first and fifth days challenge,bacterial counts on implanted catheters and in surrounding tissues were determined microbiologically.Bacterial colonization and biofilm formation on implanted catheters were assessed by scanning electron microscopy.Results Drug release from levofloxacin-impregnated catheters was rapid.Levofloxacin-impregnated catheters had significantly fewer bacteria compared to PVC in vitro.After first and fifth day of challenge,no or significantly fewer bacteria adhered to impregnated catheters or in surrounding tissues compared to PVC.Scanning electron microscopical images after first day displayed from none to significantly fewer bacteria adhering to impregnated implanted catheters,compared to bacteria and microcolonies adhering to PVC catheters.After the fifth day,no bacteria were found on impregnated catheters,compared to clusters surrounding mucus-like substance and coral-shaped biofilms with polymorphonuclear leukocyte on PVC catheters.After the first day of challenge,secretion occurred in all implanted catheters with surrounding tissues mildly hyperaemic and swollen.After the fifth day,minute secretions inside impregnated catheters and no inflammation in tissues,whereas purulent secretion inside PVC catheters and abscesses in surrounding tissues.Conclusion Levofloxacin-impregnated catheter is a promising new strategy for prevention of catheter-related Psuedomonas aeruginosa infection.

人中性粒细胞载脂蛋白、降钙素原、白介素-6对危重患者发生导管相关性血流感染的早期诊断价值

目的探讨人中性粒细胞载脂蛋白(HNL)、降钙素原(PCT)、白介素-6(IL-6)对长期留置中心静脉导管的危重患者发生导管相关性血流感染(CRBSI)的早期诊断价值。方法选取2022年1月至2023年9月山东第一医科大学第二附属医院重症医学科收治的189例留置中心静脉导管患者为研究对象,按照是否发生CRBSI分为CRBSI组(n=63)和非CRBSI组(n=126)。收集患者临床特征资料及留取血培养当天的HNL、PCT、IL-6结果。采用logistic回归分析建立HNL、PCT和IL-6的联合检测模型。采用受试者工作特征(ROC)曲线评价各项指标对危重患者发生CRBSI的早期诊断价值。结果CRBSI组HNL、PCT、IL-6水平均高于非CRBSI组,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,HNL、PCT、IL-6及联合检测模型诊断CRBSI的ROC曲线下面积(AUC)分别为0.950、0.901、0.828、0.964,差异有统计学意义(P<0.05)。HNL、PCT、IL-6诊断CRBSI的最佳临界值分别为248.51 ng/ml、0.62 ng/ml、32.68 pg/ml,灵敏度分别为81.0%、79.4%、84.1%,特异度分别为99.2%、86.4%、69.6%。一致性检测结果显示,联合检测模型结果与预测诊断CRBSI存在较好的一致性(Kappa=0.810,P<0.05),HNL≥248.51 ng/ml与预测诊断CRBSI存在较好的一致性(Kappa=0.804,P<0.05)。结论相比于PCT、IL-6,HNL对危重患者发生导管相关性血流感染有较好的早期诊断价值。

2014-2022年单中心血液透析导管相关血流感染病原学分析

目的分析维持性血液透析(MHD)患者导管相关血流感染(CRBSI)的病原学变化。方法选取2014年1月至2022年12月期间于我院行MHD的231例患者,按照患者是否发生CRBSI分为CRBSI组(n=197)、非CRBSI组(n=34)。结果CRBSI组197例患者中共检出57株病原菌,以革兰阴性菌为主;金黄色葡萄球菌对青霉素、头孢呋辛、苯唑西林有较高的耐药率,大肠埃希菌对复方磺胺甲恶唑、头孢曲松有较高的耐药率,肺炎克雷伯菌对复方磺胺甲恶唑、氨曲南有较高的耐药率;年龄≥60周岁、置管时间≥2周、合并慢性疾病、1月内无抗菌药物使用史是CRBSI的独立危险因素(P<0.05)。结论MHD患者由于高龄、合并慢性疾病、置管时间较长、近期无抗菌药物使用史而面临较高的CRBSI发生风险,而病原菌则以革兰阴性菌为主。

连续静脉-静脉血液滤过救治血透导管相关性感染一例

感染是维持性血液透析患者常见的并发症,也是其死亡的主要原因之一,我科采用连续静脉-静脉血液滤过救治一例导管相关性感染患者,本文对其诊治经过及体会进行报道。

米诺环素-利福平中心静脉导管抗感染效果的Meta分析

[目的]采用系统评价方法,比较米诺环素-利福平中心静脉导管与普通中心静脉导管的抗感染效果。[方法]系统检索Cochrane Library、PubMed、EMBASE、CINAHL、中国生物医学文献数据库、中国知网、万方数据库、维普期刊全文数据库及随机对照实验注册网站中关于米诺环素-利福平中心静脉导管与普通导管比较的随机对照试验。检索时间从建库至2017年10月。由两名研究者独立进行文献检索、文献筛选、资料提取和质量评价,采用RevMan 5.2软件对数据进行分析。[结果]共纳入8篇文献,均为随机对照试验。Meta分析显示,与普通中心静脉导管比较,米诺环素-利福平中心静脉导管能降低导管相关性血流感染的发生率[RR=0.27,95%CI(0.16,0.44),P<0.000 01]和细菌定植的发生率[RR=0.44,95%CI(0.32,0.60),P<0.000 01]。[结论]应用米诺环素-利福平中心静脉导管能有效降低导管相关性血流感染及细菌定植的发生率。

基于FOCUS-PDCA护理程序的集束化干预策略预防CRBSI的临床应用效果

目的:探讨运用FOCUS-PDCA护理程序的集束化干预策略预防中心静脉导管相关性血流感染(CRBSI)的临床应用效果。方法:基于FOCUS-PDCA程序,通过发现问题、成立小组、查找原因、明确规范,有目标、有计划地进行ICU-CRBSI护理持续质量改进。建立ICU-CRBSI质量控制小组,将CRBSI失效模式评估方法引入FOCUS-PDCA程序管理,引入清单管理方法对CRBSI置管操作和导管维护进行质量管理,应用最佳证据的集束化干预策略控制CRBSI感染的发生。结果:基于FOCUS-PDCA护理程序的集束化干预策略实施后,ICU-CRBSI质量控制小组成员的手卫生、皮肤消毒、接头消毒执行率提高;2015年~2017年ICU-CRBSI频次呈现逐年下降趋势,差异有统计学意义(均P<0.05);置管天数明显下降,且波动幅度降低。结论:采用集束化干预策略能有效减低CRBSI的发生率,减少患者的置管天数。

多式联运-清单干预法对导管相关血流感染的预防作用

目的:探讨多式联运—清单干预法对中心静脉导管相关血流感染(CRBSI)发生率的影响。方法:将重症监护病房(ICU)3 198例中心静脉置管患者作为研究对象,第一阶段(2010年1月至2011年6月)721例、5 884个导管日采用传统的管理方法,为对照组;第二阶段(2012年1月至2014年12月)1 535例、6 396个导管日采用多式联运干预措施,为干预组;第三阶段(2015年1月至2016年12月)942例、5 993个导管日采用多式联运—清单干预法,为清单干预组;比较3组患者干预后CRBSI发生率、干预措施执行率、病死率等情况。结果:与对照组比较,干预组和清单干预组CRBSI发生率、ICU住院时间、平均置管时间、病死率明显降低,干预措施执行率明显增加,且清单干预组干预措施执行率高于干预组,差异均有统计学意义(均P<0.05)。结论:与传统的管理方法相比,多式联运—清单干预法能有效降低CRBSI的发生率,缩短ICU住院时间和置管时间,明显降低患者病死率。

经颈胸部长段皮下隧道-颈内静脉-中心静脉导管植入术改善老年患者导管相关性血流感染的临床应用

【目的】探讨经颈胸部长段皮下隧道,内静膝-中心静脉导管植入术(LSJICC)改善老年患者导管相关性血流感染(CRBSIs)的临床应用价值。【方法】选择2013年1月至2016年10月入住本院需要中心静脉插管治疗的老年患者346例,对所有患者进行为期1年的随访,对CRBSIs患者进行病原菌分布分析,利用Cox回归模型筛选影响CRBSI患者预后的独立影响因素。【结果】患者预后不良率为9.54%;CRBSIs的病原菌分布排名前三位的依次为金黄色葡萄球菌、鲍曼不动杆菌和假丝酵母菌;多因素Cox回归昱示年龄、吸烟、置管时间、染菌类型及疾病类塑对患者术后不良预后有显著影响(P<0.05)。【结论】LSJICC对于预防老年患者CRBSIs有一定的临床价值。

FOCUS-PDCA方法学在控制CRBSI过程中的应用及效果

目的探讨运用FOCUS-PDCA程序预防控制重症监护室(ICU)导管相关血流感染(CRBSI)的效果。方法运用FOCUS-PDCA程序分析中心静脉置管以及护理操作流程中的各个环节,明确CRBSI发生的具体原因;成立持续质量控制(CQI)小组并对ICU护士进行培训,对操作流程进行改进和监督,形成良性循环。结果运用FOCUS-PDCA程序干预前(2010年1—12月),ICU的CRBSI发病率为8.29‰;经干预后(2011年1月—2012年12月),CRBSI的发病率降至3.20‰,差异具有统计学意义(χ2=14.6,P<0.001)。结论运用FOCUS-PDCA程序控制CRBSI的发病率是有效的。

2015-2019年某医院ICU“三管”感染状况及院感控制图的监控分析

目的探讨院感控制图在重症医学科(ICU)"三管"感染管理中的应用价值,为院感的控制提供指导。方法收集2015年1月至2019年12月某医院ICU病房每月的"三管"感染监控记录,采用SPSS 19.0软件对收集的数据资料进行统计学分析,利用生成的院感控制图对ICU"三管"感染情况进行监控,及时发现问题并予以改进。结果 2015年1月至2019年12月期间该院ICU病房每月新收患者30~96例,每月新发CLABSI 0~5例,每月中心静脉插管总时长202~449 d,CLABSI发生率为0~14.71例/千导管日,每月新发CAUTI 0~6例,每月尿道插管总时长213~449 d,CAUTI发生率为0~19.01例/千导管日,每月新发VAP 0~5例,每月使用呼吸机总时长198~449 d,VAP发生率0~19.01例/千导管日。每个月CLABSI、CAUTI及VAP发生率各数据监控点均落在控制限内,均在中心线上下波动,各数据点无异常排列。每个月CLABSI、CLABSI、CAUTI及VAP发生率有个别数据点落在警戒限外,其余数据点均在警戒限内,且无异常排列,"三管"感染均在受控状态。结论借助院感质量控制图能够科学、直观地对ICU"三管"感染状况进行分析,具有操作简便、结果直观、发现问题及时等特点,可广泛应用于ICU院感日常监控中。

ChE、hs-CRP、PCT与老年维持性透析IPS分值关系及联合诊断导管相关感染价值

目的探究胆碱酯酶(ChE)、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)与老年维持性透析患者感染可能性评分(IPS)分值的关系及联合诊断导管相关感染的价值。方法选取安徽省六安市中医院血液净化中心老年维持性透析患者102例,根据是否发生导管相关感染分为感染组(28例)与未感染组(74例),比较两组临床资料、IPS评分、血清ChE、hs-CRP、PCT水平,分析各血清指标与IPS评分、导管相关感染的关系,评价血清ChE、hs-CRP、PCT诊断价值。结果感染组透析时间≥1年患者比例71.43%(20/28)、贫血患者比例42.86%(12/28)、低蛋白血症患者比例50.00%(14/28)、糖尿病患者比例35.71%(10/28)、IPS分值(14.02±2.79)分均高于未感染组,差异有统计学意义(P<0.05);感染组血清ChE低于未感染组,血清hs-CRP、PCT水平高于未感染组,差异有统计学意义(P<0.05);血清ChE与老年维持性透析患者IPS分值呈负相关,hs-CRP、PCT与IPS分值呈正相关,且均为导管相关感染发生的影响因素(P<0.05);血清ChE、hs-CRP、PCT联合诊断导管相关感染的曲线下面积(AUC)为0.923。结论血清ChE、hs-CRP、PCT与老年维持性透析患者IPS分值密切相关,各指标联合在导管相关感染诊断方面具有较高诊断效能。

血清YKL-40、NGAL、PTM与尿毒症血透患者导管相关性感染的关系及预测价值研究

目的 探讨尿毒症血透患者血清几丁质酶3样蛋白1(YKL-40)、中性粒细胞明胶酶相关载脂蛋白(NGAL)、血栓调节蛋白(PTM)与导管相关性感染的关系及预测价值。方法 回顾性分析2021年6月—2022年6月海南医学院第一附属医院收治的150例尿毒症血透患者的临床资料,根据患者是否发生导管相关性感染分为感染组(36例)和未感染组(114例)。比较两组患者性别、年龄、体质量指数(BMI)、尿毒症病程、血透时间、居住地区、插管次数、置管时间、置管部位、有无糖尿病及高血压等临床资料,检测血红蛋白(Hb)、铁蛋白(SF)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、YKL-40、NGAL、PTM水平。采用一般多因素Logistic回归性模型分析尿毒症血透患者发生导管相关性感染的危险因素,通过受试者工作特征(ROC)曲线分析导管相关性感染模型预测尿毒症血透患者发生导管相关性感染的效能。结果 感染组与未感染组性别构成、BMI、尿毒症病程、血透时间、居住地区、插管次数、高血压、Hb、SF、TC、TG、HDL-C和LDL-C水平比较,差异均无统计学意义(P>0.05);感染组年龄≥60岁、置管时间≥4 d、股静脉置管、有糖尿病的患者占比高于未感染组,YKL-40、NGAL、PTM水平高于未感染组(P <0.05)。ROC曲线分析结果表明,YKL-40、NGAL、PTM预测尿毒症血透患者发生导管相关性感染的曲线下面积(AUC)分别为0.821、0.874和0.853,临界值分别为45.705 ng/mL、69.390 ng/mL和34.845 ng/L,敏感性分别为72.2%、80.6%和77.8%,特异性分别为78.1%、90.4%和86.0%。一般多因素Logistic回归分析结果显示,年龄≥60岁[^OR=2.189(95%CI:1.211,3.957)]、置管时间≥4 d [^OR=3.276(95%CI:1.408,7.622)]、股静脉置管[^OR=3.007(95%CI:1.285,7.037)]、糖尿病[^OR=2.343(95%CI:1.305,4.207)]、YKL-40≥45.705 ng/mL [^OR=1.967(95%CI:1.174,3.296)]、NGAL≥69.390 ng/mL [^OR=2.259(95%CI:1.318,3.872)]、PTM≥34.845 ng/L [^OR=2.070(95%CI:1.229,3.486)]是尿毒症血透患者发生导管相关性感染的危险因素(P <0.05)。根据一般多因素Logistic回归分析结果建立导管相关性感染预测模型,Logit(P)=-35.912+0.783X年龄+1.187X置管时间+1.101X置管部位+0.851X糖尿病+0.677XYKL-40+0.815XNGAL+0.728XPTM。ROC曲线结果表明,模型预测导管相关性感染发生的AUC为0.959,标准误为0.019,临界值为9.865,敏感性为94.4%(95%CI:0.897,0.983),特异性为86.0%(95%CI:0.818,0985)。导管相关性感染预测模型敏感性优于YKL-40、NGAL、PTM单独预测。结论 尿毒症血透患者血清YKL-40、NGAL、PTM与导管相关性感染有关,血清YKL-40、NGAL、PTM对尿毒症血透患者导管相关性感染有较好的预测价值,且各项指标联合预测的敏感性优于各指标单独预测。

血清hs-CRP、MCP-1与终末期肾病患者血液透析导管相关性感染的相关性

目的探析血清超敏C-反应蛋白(hs-CRP)、单核细胞趋化蛋白-1(MCP-1)与终末期肾病(ESRD)患者血液透析导管相关性感染(CRI)的相关性。方法本研究采用横断面研究,纳入济源市第二人民医院2019年1月至2021年10月行血液透析治疗的118例ESRD患者,观察全部患者随访6个月时的血液透析CRI发生情况。检测所有患者的血清hs-CRP、MCP-1水平,统计两组基线资料,重点分析血清hs-CRP、MCP-1水平与ESRD患者血液透析CRI的关系。结果115例患者中,有20例发生CRI,发生率为17.39%;与未发生组比较,发生组血清hs-CRP、MCP-1水平增高,白蛋白水平降低(P<0.05);经双变量Pearson相关系数检验,ESRD患者血清hs-CRP、MCP-1水平之间呈正相关(P<0.05);经双变量Kendall's tau-b相关系数检验,ESRD患者血清hs-CRP、MCP-1水平与血液透析CRI的发生呈正相关(r>0,P<0.05);血清白蛋白水平与血液透析CRI的发生呈负相关(r<0,P<0.05);建立logistic回归分析结果显示,血清hs-CRP、MCP-1、白蛋白水平与SRD患者血液透析CRI的发生有关(P<0.05)。结论血清hs-CRP、MCP-1水平与ESRD患者血液透析CRI的发生存在一定的关系。

监测-培训-计划干预模式在ICU导尿管相关尿路感染中的应用

目的:探讨监测-培训-计划干预模式应用于重症监护室导尿管相关尿路感染的防控效果。方法:选取2019年4月—2020年4月我院200例重症监护室留置导尿管病人,按随机数字表法分为对照组和观察组,各100例。对照组行常规干预,观察组行监测-培训-计划干预模式,比较两组导尿管相关尿路感染发生率、留置导尿管防控措施执行率及正确率、护理质量及生活质量。结果:观察组导尿管相关尿路感染发生率低于对照组;留置导尿管防控措施执行率及正确率高于对照组;护理质量优于对照组;生理功能、生理职能、躯体疼痛、活力及总体健康评分均高于对照组,差异均有统计学意义(P<0.05)。结论:监测-培训-计划干预模式应用于重症监护室可提升导尿管相关尿路感染各环节防控质量、护理质量,改善病人生活质量,降低导尿管相关尿路感染发生率。