1028例危重血液净化患者血管通路相关感染回顾分析

目的探讨危重血液净化患者血管通路相关感染的发生情况。方法回顾性分析广东省人民医院近2年(2010年1月1日～2011年12月31日)1028例在监护室行连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)或床边间歇性血液透析(intermittent hemodialy,IHD)治疗的患者血管通路情况,分析导管相关的局部感染(catheter-related local infection,CRLI)和导管相关血行感染(catheter related blood stream infection,CRBSI)的发生率。结果总的置管例次和导管使用时间分别为:1123例次和16845导管日;颈内静脉:215例次和3665导管日;股静脉:908例次和13580导管日;CRRT组:918例次和14688导管日;床边IHD组:295例次和2157导管日。CRLI发病率股静脉高于颈静脉(4.79%与2.72%,P0.05);CRRT与IHD组无明显差异(4.43%与4.63%,P0.05)。CRBSI的发生率股静脉高于颈静脉(3.24%与1.64%,P0.05),CRRT组高于IHD组(3.13%与1.85%,P0.05)。结论危重血液透析患者血管通路仍首选颈内静脉,其感染发生率低于股静脉;CRRT组CRBSI发生率高于床边IHD组,CRRT是否增加CRBSI发生率,目前仍需要更多前瞻性研究予以证实。

A retrospective analysis of catheter-related infections in 1028 critical cases with blood purification

Objective To explore the catheter-related infections in critical patients with blood purification. Methods This is a retrospective analysis conducted by the Intensive Care Unit of Guangdong General Hospital. All patients admitted to the ICU during the 2 years period from January 1, 2010 to December 30, 2011 and treated with continuous renal replacement therapy (CRRT) or intermittent hemodialysis (IHD) were included. Results A total of 1,028 patients were included in this study. The total number of catheterization and catheterization days were 1,123 times and 16,845 days, including jugular catheterization 215 times and 3,665 days, femoral catheterization 908 times and 13,580 days, respectively. The total number of catheterization and catheterization days were 918 times and 14,688 days, respectively, in CRRT group, and were 295 times and 2,157 days, respectively, in IHD group. The incidence of catheter-related local infection (CRLI) was statistically higher in catheterization patients using femoral route than in those using jugular route (4.79% vs 2.72%, P < 0.05), but was indifferent between patients with CRRT and those with IHD (4.43% and 4.63%, P > 0.05). The incidence of catheter related blood stream infection (CRBSI) was statistically higher in catheterization patients using femoral route than in those using jugular route (3.24% vs 1.64%, P<0.05), and was higher in patients with CRRT than those with IHD (3.13% and 1.85%, P < 0.05). Conclusion For critically ill patients required hemodialysis, blood access through internal jugular vein is preferable with the lower infection incidence than that through femoral vein. The incidence of CRBSI was higher in patients with CRRT than those with IHD. However, whether CRRT actually increases the CRBSI incidence needs to be further studied.