心脏瓣膜替换术后中心静脉置管相关感染的调查分析

目的：探索心脏瓣膜替换术后经锁骨下或颈内静脉通道中心静脉置管的感染情况。方法自2010年1月～2013年1月行瓣膜替换手术520例，随机将其分成两组，一组选择颈静脉置管，另一组选择锁骨下静脉置管，比较两组的细菌感染率；比较静脉置管第5、6～10、11～20、20d以上不同时间段的感染率。结果不同穿刺部位病例中心静脉置管相关感染（CVC-RI）的发生率，颈内静脉置管为16．3％，高于锁骨下静脉置管9．5％（ P ＜0．05）。不同导管留置时间CVC-RI的发生率，520例中发生导管感染留置时间为5d～30 d ，随着留置时间的延长感染率增加，以第11～20d最为明显。结论应根据静脉导管的使用原则，合理留置中心静脉置管，并缩短导管留置时间。

THE SURVEY AND ANALYSIS OF RELATED INFECTIONS OF CENTRAL VEIN CATHETERIZATION AFTER HEART VALVE REPLACEMENT

Objective To explore the central vein catheterization-related infections （CVC-RI） after heart valve replacement infraclavicula and internal jugular vein .Methods 520 cases treated with cardiac valve re-placement from January ,2010 to January ,2013 were randomly divided into two groups .One group was treated with cardiac valve replacement through internal jugular vein ,and another group was treated with cardiac valve replacement through infraclavicula .The rates of bacterial infection in the two groups were compared ,and the infectious rates on the 5th day ,during the 6th-the 10th days ,during the 11th-the 20th days ,and on the 20th day after central vein catheterization were also compared .Results The incidence of CVC-RI through internal jugular vein was 16 .3% ,and that through infraclavicula was 9 .5% （P〈0 . 05） .In the 520 patients ,the infections time of dwelling catheter was 5-30 days .The incidence of CVC-RI increased with time ,especially during the 11th - the 20th days .Conclusion Central vein catheterization should be reasonably used and the time of indwelling catheter should be reduced according to the principle of venous catheter application .