周期性预防性抗生素封管在PICC长期带管患者中预防导管相关血行感染的应用价值

目的探讨周期性预防性抗生素封管在外周导入中心静脉置管（PICC）长期带管患者中预防导管相关血行感染（Catheter-related bloodstream infection,CRBSI）的价值。方法将因临床需要PICC置管并长期带管治疗的89例患者随机分为观察组46例和对照组43例。观察组每隔30d采用5mg万古霉素和300U肝素钠加于5ml生理盐水封管连续封管6d,其他时间采用300U肝素钠加于5ml生理盐水封管。对照组采用300U肝素钠加于5ml生理盐水封管。比较两组间导管留置时间和CRBSI的发生率。结果观察组导管留置时间为（77.1±33.8）d,与对照组的（68.2±28.4）d比较,差异无统计学意义（t=1.331,P=0.187）。观察组CRBSI发生率为0.28/1000导管留置日,对照组为1/1000导管留置日,两组间差异无统计学意义（χ2=1.426,P=0.232）。结论采用周期性预防性抗生素封管不能提高PICC留置时间和降低CRBSI的发生率,由于高浓度抗生素封管有潜在产生耐药菌的风险和增加患者医药费支出,不适合在临床推广。

Value of periodic prophylactic antibiotic sealing tube to prevent catheter-related bloodstream infection in long term usage of peripherally inserted central catheters

Objective To investigate value of periodic prophylactic antibiotic sealing tube to prevent catheter-related bloodstream infection(CRBSI) in long term usage of peripherally inserted central catheters(PICC).Methods 89 patients,who wanted long term usage of PICC for clinical purposes,were randomly divided into observation group(n=46) and control group(n=43).Patients in the observation group received six-day prophylactic antibiotic sealing tube periodically at an interval of 30 days.During these days the tube was sealed with heparin-saline solution(300U heparin in 5ml saline solution).Patients in the control group received heparin-saline solution to seal the tube.The data of duration of tube and occurrence rate of CRBSI were analyzed between two groups.Results The durations of tube in observation group and control group were 77.1 d±33.8 d and 68.2 d±28.4 d,and there was no significant difference between two groups;the occurrence rates of CRBSI in observation group and control group were 0.28/1 000 the usage days of PICC and 1/1 000 the usage days of PICC,and there was no significant difference between two groups.Conclusion Periodic prophylactic antibiotic sealing can not lengthen the durations of tube and reduce the occurrence rates of CRBSI,and hence it can not be spread.