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NICU早产儿PICC导管相关血流感染高危因素的Meta分析
《现代预防医学》[ISSN:1003-8507/CN:51-1365/R]年: 2020卷: 47期:09栏目:临床与预防页码:1708-1713出版日期:2020-05-15
| Title: | Title: High risk factors for PICC catheter-related bloodstream infection in preterm infants in NICU: a meta-analysis |
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| 作者: | 作者： |
| Author(s): | Author(s): |
| 单位: | 单位: 1.宁夏医科大学护理学院，银川 750004； |
| Unit: | Unit: *Nursing College, Ningxia Medical University, Yinchuan, Ningxia 750004, China |
| 关键词: | 关键词: |
| Keywords: | Keywords: Premature infants; PICC; Catheter-related bloodstream infections; Risk factors; Meta-analysis |
| 分类号: | 分类号: R722.6 |
| 文献标识码: | 文献标识码: A |
| 摘要: | 摘要: 目的 通过Meta分析客观地确定NICU早产儿PICC导管相关血流感染的主要高危因素，为预防早产儿PICC导管相关血流感染提供一定的循证证据支持。方法 在线检索CNKI、万方、维普、Cochrane Library、PubMed、EMBASE等数据库，检索年限从各数据库建库起始至2019年1月，有关公开发表的早产儿PICC导管相关血流感染高危因素的文献，由两名研究员独立完成文献筛选、质量评价及资料提取，采用RevMan5.3软件进行Meta分析。结果 经筛选共纳入10篇文献（中文1篇，英文9篇）进行Meta分析。胎龄＜32周(OR=0.26, 95%CI:0.10~0.66)，出生体重＜750g(OR=0.53, 95%CI:0.41~0.69)，股三角部位置管(OR=1.67, 95%CI:1.31~2.11)，置管耗时≥60min(OR=0.61, 95%CI:0.38~0.97)，留置管时间≥30天(OR=2.41, 95%CI:1.75~3.31)，留置CVC导管数量≥2个(OR=0.21, 95%CI:0.17~0.25)是高危因素。结论 胎龄愈小、出生体重越低、经股三角部位置管、置管耗时和导管留置时间越长、留置多个CVC导管是早产儿PICC置管后发生导管相关血流感染的高危因素，医护人员可采取有效预防措施，降低导管相关血流感染的发生率。 |
| Abstract: | Abstract: Objective To investigate the main risk factors of PICC catheter-related bloodstream infection in premature infants in NICU by meta-analysis, and to provide a theoretical basis for the prevention of PICC catheter-related bloodstream infection in premature infants. Methods CNKI, Wanfang, Weipu, Cochrane Library, PubMed and EMBASE databases were retrieved online. Literatures on high risk factors of PICC catheter-related blood flow infections in premature infants published from date of the establishment of databases to January 2019 were independently screened, evaluated and extracted by two researchers. RevMan 5.3 software was used for meta-analysis. Results A total of 10 literatures (1 in Chinese and 9 in English) were selected for meta-analysis. The gestational age<32 weeks (OR=0.26, 95%CI: 0.10-0.66), birth weight<750 g (OR=0.53, 95%CI: 0.41-0.69), catheterization at triangle of femur (OR=1.67, 95%CI: 1.31-2.11), catheterization time ≥60 minutes (OR=0.61, 95%CI: 0.38-0.97), indwelling catheter time≥30 days (OR=2.41, 95%CI: 1.75-3.31), and the number of indwelling CVC catheters≥2 (OR=0.21, 95%CI: 0.17-0.25) were high risk factors. Conclusion The smaller the gestational age, the lower the birth weight, the position of the transfemoral triangle, the longer time spent in the catheterization process and the catheter indwelling time, and the retention of multiple CVC catheters are the main causes of catheter-related bloodstream infection after PICC placement in preterm infants. Medical staff can take effective preventive measures against these high-risk factors to reduce the incidence of catheter-related bloodstream infections. |
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参考文献 /References: | 参考文献
［2］ Rajput N， Filipovska J， Hewson M. The effects of routine administration of probiotics on the length of central venous line usage in extremely premature infants［J］. The Turkish Journal of Pediatrics，2017，59( 1) : 20 － 27. ［3］ 黄星，高晓东，袁征. 老年患者导管相关性血流感染的预防与护理［J］. 中华医院感染学杂志，2019，29( 2) : 308 － 311，320. ［4］ Colacchio K，Deng Y，Northrup V，et al. Complications associated with central and non － central venous catheters in a neonatal intensive care unit［J］. Journal of Perinatology，2012，32 ( 12) :941 － 946. ［5］ Ming － Horng T，Shih － Ming C，Reyin L，et al. Complications associated with 2 different types of percutaneously inserted central venous catheters in very low birth weight infants［J］. Infection Control and Hospital Epidemiology，2011，32( 3) : 258 － 266. ［6］ Bashir R，Swarnam K， Vayalthrikkovil S， et al. Association between Peripherally Inserted Central Venous Catheter Insertion Site and Complication Rates in Preterm Infants［J］. American Journal of Perinatology，2016，33( 10) : 945 － 950. ［7］ Milstone AM，Reich NG，Advani S，et al. Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study［J］.Pediatrics，2013，132( 6) : e1609 － e1615. ［8］ Ming － Horng T，Reyin L，Jiunn － Wei W，et al. Complication rates with central venous catheters inserted at femoral and Non －Femoral sites in very low birth weight infants［J］. The Pediatric Infectious Disease Journal，2009，28( 11) : 966 － 970. ［9］ Sanderson E，Yeo KT，Wang AY，et al. Dwell time and risk of central － line － associated bloodstream infection in neonates［J］.The Journal of Hospital Infection，2017，97( 3) : 267 － 274. ［10］ Geffers C，Gastmeier A，Schwab F，et al. Use of central venous catheter and peripheral venous catheter as risk factors for nosocomial bloodstream infection in Very － Low － Birth － Weight infants［J］.Infection Control and Hospital Epidemiology : the Official Journal ofthe Society of Hospital Epidemiologists of America，2010，31( 4) :395 － 401. ［11］ Jen － Fu H，Ming － Horng T，Hsuan － Rong H，et al. Risk factors of catheter － related bloodstream infection with percutaneously inserted central venous catheters in very low birth weight infants: acenter＇s experience in Taiwan［J］. Pediatrics ＆ Neonatology，2010，51( 6) : 336 － 342. ［12］ Brooker RW，Keenan WJ. Catheter related bloodstream infection following PICC removal in preterm infants ［J］. Journal of Perinatology: Official Journal of the California PerinatalAssociation，2007，27( 3) : 171 － 174. ［13］ Shalabi M，Adel M，Yoon E，et al. Risk of infection using peripherally inserted central and umbilical catheters in pretermneonates［J］. Pediatrics，2015，136( 6) : 1073 － 1079. ［14］ 帅春，封志纯，汪灏，等. 极低出生体质量儿置入中心静脉导管相关血流感染的临床研究［J］. 临床儿科杂志，2015，33( 1) : 9 －12. ［15］ Aly H，Herson V，Duncan A，et al. Is bloodstream infection preventable among premature infants? A tale of two cities［J］.Pediatrics，2005，115( 6) : 1513 － 1518. ［16］ 刘晓兰. 早产儿感染性疾病的主要发病原因及临床特点分析［J］. 中国现代药物应用，2015，9( 24) : 276 － 277. ［17］ Sastre JL，Cotallo DC，Colomer BF，et al. Neonatal sepsis of nosocomial origin: an epidemiological study from the " Grupode Hospitales Castrillo"［J］. Journal of Perinatal Medicine，2002，30( 2) : 149 － 157. ［18］ 黄银娟，刘莹，徐月银. 早产儿 372 例院内感染病原体分布特点及危险因素分析［J］. 齐鲁护理杂志，2016，22( 5) : 62 － 63，64. ［19］ 孙宏梅，郭莹，韩晶，等. 导管相关性血流感染的危险因素分析及对策［J］. 继续医学教育，2017，31( 12) : 96 － 98. ［20］ 范润平，龚青霞，巩文花，等. ICU 患者中心静脉导管血流感染危险因素的 Meta 分析［J］. 中国感染控制杂志，2018，17 ( 4) :335 － 340. ［21］ Koh DB，Gowardman JR，Rickard CM，et al. Prospective study of peripheral arterial catheter infection and comparison with concurrently sited central venous catheters ［J］. Critical CareMedicine，2008，36( 2) : 397 － 402. ［22］ 李丽蓉，陈甲信，傅桂芬，等. PICC 相关感染危险因素的 Meta 分析［J］. 中华医院感染学杂志，2017，27( 1) : 113 － 116. ［23］ Ainsworth S，Mcguire W. Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition inneonates［J］. Cochrane Database of Systematic Reviews，2015，6( 10) : CD004219. |
| 备注/Memo: | 备注/Memo: 基金项目:国家自然科学基金资助项目(编号：81660385) |
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