急性白血病病人经外周静脉中心静脉置管 相关性感染的危险因素分析

目的通过分析急性白血病病人经外周静脉中心静脉置管（PICC）发生置管相关感染（CRI）的危险因素，以期为临床护理工作提供可行性策略。方法收集成功进行PICC的132例急性白血病病人的临床资料，统计并分析病人的一般临床资料、置管时间、穿刺次数、是否应用化疗药物、是否使用激素、免疫功能是否低下、CRI发生的季节与CRI发生的相关性，并对CRI病人置管分泌物培养的结果进行分析。结果132例病人中共发生CRI 21例，总感染率为15.91%；CRI发生与急性白血病分型、性别、年龄无相关性（P>0.05）；置管时间长、穿刺次数多、化疗药物的应用、激素用药史、免疫功能低下以及夏季感染率分别高于置管时间短、穿刺次数少、未应用化疗药物、无激素用药史、免疫功能正常者以及春、秋、冬季感染率（P < 0.05~P < 0.01）；发生CRI的病人中有2例未行分泌物培养检查，其余19例病人的分泌物培养结果显示葡萄球菌、克雷伯杆菌、棒状杆菌以及其他菌群的感染构成比分别为52.6%、21.1%、21.1%、5.2%。结论通过尽量缩短置管时间、减少穿刺次数、增强免疫治疗、严格控制激素应用指征以及选择以覆盖球菌为主的抗生素进行预防性治疗可能避免或者控制急性白血病病人PICC置管感染的发生。

Analysis of the risk factors of CRI in acute leukemia patients treated with PICC

ObjectiveTo analyze the risk factors of catheter-related infection (CRI) in acute leukemia patients treated with peripherally inserted central catheter (PICC) to provide the reasonable strategies for clinical nursing care.MethodsThe clinical data of 132 acute leukemia patients treated with PICC were successfully collected.The general clinical data, length of catheterization, number of puncture, application of chemotherapy drugs, use of hormone and immune function in all patients were analyzed.The correlation of CRI occurrence with season, and secretion culture results of CRI patients were analyzed.ResultsAmong 132 patients, 21 cases with CRI were found, and the infection rate of which was 15.91%.The CRI occurrence was not related to the classification of acute leukemia, gender and age (P>0.05).The infection rates in patients with long time of catheter indwelling, more punctural times, chemotherapy drug use, history of use hormone and low immune function, and at summer were higher than that in patients with short time of catheter indwelling, few punctural time, no use of chemotherapy drug, no hormone history and normal immune function, and at spring, autumn and winter (P < 0.05 to P < 0.01).Among 21 CRI patients, the secretion in 2 cases were not examined.The secretion culture results of the rest 19 patients showed that the proportions of Glucose aureus, Klebsiella bacillus, corynebacterium and other bacteria infection were 52.6%, 21.1%, 21.1% and 5.2%, respectively.ConclusionsShortening the PICC catheter indwelling time, reducing the punctural time, strengthening the immune treatment, controlling the use of hormone and choosing the antibiotics based on main coccus infection for preventive treatment can avoid and control the CRI in acute leukemia patients treated with PICC.