血液透析患者临时中心静脉导管相关感染的回顾性研究

目的 通过对临床病例资料的回顾性研究,探讨使用临时中心静脉导管的血液透析患者发生中心静脉导管相关感染（Central venous catheters related infections,CVC-RI）的情况及危险因素.方法 以同济大学附属东方医院肾内科2010年1月至2013年6月临时中心静脉插管的132例血液透析患者为研究对象,收集资料,分析CVC-RI的发生情况及危险因素.结果 ①132例患者中,共行中心静脉置管术149例次,符合中心静脉导管相关感染诊断标准的病人31例,CVC-RI发病率为23.5％.②置管后发生感染的时间最短9d,最长41d,不同置管时间的感染率有统计学差异（P＜0.05）.③颈内静脉和股静脉置管的感染分别为13例（41.9％）和18例（58.1％）.二者比较无统计学意义（P＞0.05）.④CVC-RI患者相关培养中革兰阳性菌17例（54.8％）和革兰阴性菌14例（45.2％）,二者比较无统计学差异（P＞0.05）.⑤年龄、留置时间、穿刺过程是否顺利、有无他处感染、糖尿病、是否使用免疫抑制剂均是导致CVC-RI的危险因素（P＜0.05）.结论 ①年龄、留置时间、穿刺过程是否顺利、有无他处感染、糖尿病、是否使用免疫抑制剂是导致CVC-RI的危险因素.②静脉置管时间大于2周的患者CVC-RI发生率明显增高.③颈内静脉和股静脉置管患者CVC-RI的发生无明显差异.④CVC-RI患者中革兰阳性菌和阴性菌发生感染的比例无明显差异.

Retrospective study on the temporary central venous catheter related infections in hemodialysis patients

Objective To retrospectively investigate the prevalence and risk factors of central venous catheter related infections （CVC-RI） in hemodialysis patients with venous indwelling catheters.Methods A total of 132 hemodialysis patients with short-term indwelling catheters and treated in East Hospital of Tongji University in the period from January,2010 to June,2013 were enrolled in this study.Their clinical data and the prevalence and risk factors of CVC-RI were analyzed.Results In the 132 hemodialysis patients,the catheters were located in femoral vein in 41 cases and in intemal jugular vein in 91 cases,with a total of 149 venous catheterizations.The median duration of indwelling catheterization was 27 days （8-51 days）.CVC-RI was found in 31 cases with the prevalence of 23.5％.In the 31 case,CVC-RI occurred in the first 14 days after catheterization in 4 cases （12.9％）,within 15th-21st days in 9 cases （29％）,within 22nd-28th days in 13 cases （41.9％）,and after 28 days in 5 cases （16.1％）.Therefore,the prevalence of CVC-RI was significantly variable in different duration after catheterization （P＜0.05）.The prevalence of CVC-RI was similar in patients with jugular vein catheterization and in those with femoral vein catheterization （41.9％ and 58.1％,respectively; P＞0.05）.Gram-positive bacteria were detected in 17 cases,and Gram-negative bacteria in 14 cases （54.8％ and 45.2％,respectively; P＞0.05）.The prevalence of CVC-RI correlated significantly to indwelling duration,age,infections in other sites,puncture manipulation,use of immunosuppressive agents,and diabetes （P＜0.05）.Conclusions The prevalence of CVC-RI correlated closely to indwelling duration,age,infection in other sites,puncture manipulation,use of immunosuppressive agents,and diabetes.The prevalence of CVC-RI became higher in patients with indwelling catheters for more than two weeks.The prevalence of CVC-RI was similar in patients with jugular vein catheters and in those with femoral vein catheters.The numbers of CVC-RI patients due to Gram-positive bacteria and those due to Gram-negative bacteria were approximately equal.