隧道式经外周静脉穿刺中心静脉导管相关感染致隧道穿孔成功保留导管1例报告

经 外 周 静 脉 穿 刺 中 心 静 脉 导 管(peripherally inserted central catheter,PICC)是癌症患者常用的一种中长期静脉输液治疗方式,在临床中应用广泛 [1].隧道式PICC是对传统PICC置管技术的进一步改良,通过建立皮下隧道,实现静脉穿刺点和导管体外出口分离,既扩大...     

应用抗菌药物防治外科感染的指导意见（草案）XⅢ——血管内导管相关感染

血管内导管包括外周静脉导管、非隧道式或隧道式中心静脉导管（CVC）、肺动脉导管、动脉导管和体内置入式输液泵。前瞻性研究显示，外周静脉导管留置的感染率最低（＜1％）；经皮颈内静脉或锁骨下静脉短暂留置的导管感染率约为3％～5％；用于血液透析的中心静脉导管的感染率最高，约为10％。血管内导管相关感染是危重患者病情恶化与死亡的主要原因之一。     

应用抗菌药物防治外科感染的指导意见（草案）XXⅣ——血管内导管相关感染

血管内导管包括外周静脉导管、非隧道式或隧道式中心静脉导管（CVC）、肺动脉导管、动脉导管和体内置入式输液泵。前瞻性研究显示，外周静脉导管留置的感染率最低（1％）；经皮颈内静脉或锁骨下静脉短暂留置的导管感染率约为3％～5％；用于血液透析的中心静脉导管的感染率最高，约为10％。血管内导管相关感染是重危病人病情恶化与死亡的主要原因之一。     

隧道式Cuff血液透析导管相关血流感染的预防和治疗

血管通路是血液透析成功实施的关键。隧道式Cuff血液透析导管(TCC)是内瘘成熟障碍情况下维持性血液透析的主要血管通路。导管相关血流感染(CRBSI)是TCC使用中最重要的并发症之一。本文就使用TCC的患者发生CRBSI的预防和治疗措施等方面的研究进展作一综述。     

头孢他啶封管治疗血液透析患者中心静脉导管相关感染的疗效观察

目的 探讨头孢他啶封管治疗血液透析患者中心静脉导管相关感染的疗效.方法 对2009年1月至2011年12月在我院血液净化中心治疗的15例中心静脉导管感染患者进行分析.15例患者中男6例、女9例,平均年龄(68±2)岁.其中高血压3例、慢性肾小球肾炎6例、糖尿病6例;置管部位分别为股静脉置管3例、颈内静脉置管12例(9例为颈内静脉长期留置管),留置时间14～ 370 d.15例导管感染患者中1例于3周内发生感染,2例于4周内发生感染,3例于5周内发生感染,颈内长期留置导管的9例患者在置管后4～ 12个月发生感染.对感染患者均留导管血培养,于透析当日行置管口换药,血液透析后采用普通肝素2 ml(1 2500 IU)+生理盐水稀释至2.6 ml和头孢他啶1g,用4ml的生理盐水稀释后抽取0.4ml的稀释液混合,按照导管标明的量注入,连续封管2周,以后改为每周1次.1例糖尿病患者置管口出现皮肤红、肿、热、痛,有脓性分泌物,除按上述方法封管外,每天局部予以常规消毒处理后,外用2％莫匹罗欣软膏.结果 培养结果显示铜绿假单胞菌3例,嗜麦芽假单胞菌2例,荧光假单胞菌3例,表皮葡萄球菌3例,隧道口分泌物培养表皮葡萄球菌1例,未培养出细菌者3例.在封管治疗1～2周后,15例患者导管感染者症状缓解,改为每周1次封管,连续2个月后停止封管,连续观察5个月,无再发生感染.结论 血液透析患者易发生导管感染.头孢他啶抗菌谱广,对大部分革兰阴性杆菌及金黄色葡萄球菌、表皮葡萄球菌等阳性菌有效.对中心静脉导管感染的血液透析患者采用头孢他啶封管治疗疗效显著.     

永久性经皮下隧道颈内静脉留置双腔导管26例体会

血液透析的血管通路最常用的仍是自体动静脉内瘘,但是随着老年人、糖尿病、儿童等终末性肾衰患者增多,由于患者血管条件所限,且不愿或无条件行腹膜透析[1].永久性中心静脉留置导管,目前已成为维持血透患者血管通路的极好补充.现总结本院资料完整的维持性血液透析患者26例,报道如下.     

聚维酮碘帽预防临时血液透析导管相关感染的临床研究

目的：评价自制聚维酮碘帽对血液透析患者临时导管相关感染的预防作用。方法：入选我院符合条件的血液透析患者143例,随机分为3组,A 组以0．5%肝素盐水封管＋封管帽封盖导管出口,B 组以0．4%庆大及0．5%肝素盐水封管＋封管帽封盖导管出口,C 组以0．5%肝素盐水封管＋自制聚维酮碘帽封盖导管出口。随访8周,观察导管相关感染事件,比较三组实验前相关指标及导管感染患病率,进行统计学分析。结果：A 组患者平均血浆总蛋白较低,组间差异有统计学意义（P ﹤0．05）,三组年龄、血红蛋白、血浆白蛋白、血浆球蛋白、血肌酐、血尿素氮等差异均无统计学意义。实验终止时,三组 CRI 患病率10．5%（15/143）。A 组培养阳性10例、有临床症状3例,B 组4例、有临床症状1例,C 组1例,三组差异有统计学意义（χ2=10.976,P ﹤0．01）。两两比较显示,C 组与 A 组之间差异有统计学意义（χ2=9.687,P ﹤0．01）,B 组与 A 组差异无统计学意义（χ2=3.214,P ﹥0．05）。结论：聚维酮碘局部应用可有效降低血液透析临时导管管内感染率。     

深静脉留置双腔导管感染的预防及处理

在479例次深静脉留置双腔导管中，右侧颈内静脉置管434例次，左侧颈内静脉置管24例次，有侧锁骨下静脉置管16例次，股静脉置管5例次。所有病例均为需要紧急或短时进行血液净化治疗的患者，其中大部分为等待肾移植的终末期尿毒症患者。     

经皮下隧道双腔带Cuff导管在血液透析中的应用分析

血管通路是维持性血液透析患者生命线,自体动静脉内瘘是血管通路的首选[1],但有些患者如老年、糖尿病患者,因自身血管条件差,无法建立内瘘,导致血液透析无法长期进行的患者,双腔带Cuff导管做为半永久血液通路应用逐渐增多,据报道[2],美国有25%的患者使用带Cuff中心静脉导管作为长期血透通路。现对我科16例经颈内静脉留置双腔带Cuff导管使用情况及其并发症报道如下。     

导管相关血流感染的有关问题

<正>在临床患者的医疗护理中,中心静脉导管(CVC)的功用十分重要,它可进行血流动力学监测、补液、输注药物、输血、给予肠外营养(TPN)等,这些都是周围静脉导管不能替代的[1]。但CVC也会带来15%的各种并发症,包括置入和取     

Valve System Does Not Reduce the Catheter-Related Bloodstream Infection

ABSTRACT?

Background: The Groshong catheter (GC) is considered to have a lower risk of central venous catheter-related bloodstream infection (CVC-RBSI) than conventional catheters because of its valve system (closed-end) for preventing blood reflux. However, few studies have compared the GC with conventional (open-end) catheters in terms of catheter-related complications. Purpose: To compare the incidence of catheter-related complications including CVC-RBSI between the GC and the Argyle catheter (AC). Methods: The GC and the AC were inserted in the same way from the internal jugular vein. Catheter-related complications were evaluated from the database retrospectively. Results: Two hundred seventy GCs were inserted in 123 patients, and 251 ACs were inserted in 135 patients. There were no significant differences in patient background factors between GC and AC use, except for the following two parameters. Use of GC was associated with a longer catheter insertion length and a younger patient age. Univariate analysis revealed that neither type of catheter reduced the incidence of CVC-RBSI. Kaplan-Meier analysis and log rank test revealed no significant difference between the GC and the AC in the period from insertion to development of complications. Conclusions: The GC has no superiority over the conventional AC for preventing CVC-RBSI.     

减少皮下分离的直线型隧道在经胸壁入路腔镜甲状腺切除术中的应用

目的 探讨经胸壁入路腔镜甲状腺切除术中直线型隧道的应用价值.方法 2008年3月～ 2011年6月,胸壁三孔入路行腔镜甲状腺切除术40例,术前诊断:结节性甲状腺肿20例,甲状腺腺瘤16例,甲状腺钙化灶4例.在游离皮瓣时,采用金属棒朝颈部方向直行分离,形成直线型隧道,在良好的视野下完成腔镜甲状腺手术的过程.结果 40例均于腔镜下完成手术,其中行甲状腺次全切除(单侧)28例,甲状腺切除术(单侧)5例,双侧甲状腺部分切除术5例,甲状腺癌根治术2例(此2例术中快速病理报告为甲状腺未分化癌和滤泡状癌).手术时间(78.5±18.6)min,术中出血(40.2 ±15.6)ml,术中游离皮瓣时间(14.3±3.8)min,甲状腺肿瘤直径(3.8±2.5)cm.术后24～48 h拔除引流管,术后住院(3.5±2.0)d.1例术后声音嘶哑,3个月内恢复.2例术后一过性低钙,自行恢复.未发生皮下积液和血清肿.随访12 ～36个月,平均28个月,未发现复发.术后3个月1例胸部麻木感.美观满意度调查,32例十分满意,8例满意.结论 腔镜甲状腺手术中应用直线型隧道创伤小,减少血清肿和皮肤挛缩,操作易掌握,是一种安全可行的方法.     

Effect of Shorter Term of Intravenous Infusion for Reduction of Catheter-Related Bloodstream Infection After Gastrectomy

After gastrectomy, a longer period of intravenous alimentation is required than for other digestive surgeries, portending a higher risk of catheter-related bloodstream infection (CRBSI). From assessment of CRBSI occurring between 2004 and 2007 (preintervention group), the duration of intravenous infusion between 2008 and 2010 (postintervention group) was changed to shorter-term (6-day) infusion. To verify the effect of changes in injection schedule on the incidence of CRBSI, the occurrence of CRBSI was studied comparatively among preintervention and postintervention cases, excluding cases requiring intravenous infusion preoperatively, and cases requiring long-term intravenous infusion postoperatively due to postoperative complications. The rate of CRBSI in the postintervention group (0%; 0 of 298) was significantly lower than that in the preintervention group (1.7%; 8 of 477; P = 0.026). There was no significant difference between preintervention and postintervention groups in postoperative complications. Six-day infusion decreased the incidence of CRBSI after gastrectomy significantly, without increasing postoperative complications.     

Femoral Venous Catheterization Is a Major Risk Factor for Central Venous Catheter-Related Bloodstream Infection

Background: Bloodstream infection is a major complication associated with central venous catheters (CVCs). However, there have been few studies of the risk factors for catheter-related bloodstream infection in patients who undergo colorectal surgery (CRS). Purpose: To disclose the risk factors for catheter-related bloodstream infection in CRS. Methods: Catheter-related bloodstream infection was evaluated retrospectively from a database of patients who had undergone CRS. Results: Three hundred-fifty patients received 423 CVCs for a total of 7,760 catheter days. Thirty-nine cases of catheter-related bloodstream infection (5.03 per 1,000 catheter days) were diagnosed. There were no significant differences in background between patients with or without catheter-related bloodstream infection, with the exception of the term of catheter insertion (24.6 ± 7.0 days vs.17.7 ± 0.6 days, P =. 0151). However, univariate analysis using factors of sex, age, insertion difficulty, length of the inserted catheter, term of catheter insertion, administration of chemotherapy, administration of total parenteral nutrition (TPN), kind of disinfectant, degree of surgical insult, and type of catheter revealed that use of a femoral venous catheter was an independent risk factor for catheter-related bloodstream infection (odds ratio [OR] = 3.175; 95% confidence interval [CI], 1.103–9.139; P =. 0322). Conclusions: Use of femoral venous catheters is a major risk factor for catheter-related bloodstream infection in CRS.     

皮下通道胆囊肝胆管成形术治疗肝内胆管结石

目的探讨皮下通道胆囊肝胆管成形术治疗肝内胆管结石的效果。方法2001年6月～2008年5月,采用皮下通道胆囊肝胆管成形术治疗肝内胆管结石43例。在清除结石、解除肝内外胆管狭窄、肝门整形的基础上,利用胆囊壶腹部切开相应大小的切口与切开的胆管吻合,并适当游离胆囊,使其底部可以被固定到切口皮下。要求术中基本取尽肝内结石或切除病灶。结果同时行肝切除18例（41.9%）。术后残石率39.5%（17/43）。该术式联合肝切除与未联合肝切除的残石率分别为27.8%（5/18）、48.0%（12/25）。术后出现1例胆漏,1例真菌感染。43例随访1～83个月,平均27.6月。再发胆管炎和结石3例,胆管炎发作1例,再发结石1例,均通过皮下通道切开引流、取石而治愈。结论皮下通道胆囊肝胆管成形术治疗肝内胆管结石安全、有效、微创、简便。