1 100例中心静脉置管相关性感染危险因素的logistic回归分析

目的 研究中心静脉置管相关性感染(CRS)与各种危险因素之间的相关性.方法 采用多中心病例对照分析方法,研究同期进行.1100例患者全部使用美国剑牌、德国贝朗及美国阿冈公司的中心静脉导管组,于锁骨下静脉、颈内静脉及股静脉留置导管;进行局部表面拭子细菌培养,抽导管血及外周血进行血培养,并记录性别、年龄、病种、穿刺次数、穿刺部位、导管留置时间、导管口径(单腔、双腔、血滤)、导管材质、导管护理、导管用途.先以单因素非条件logistic回归分析筛选出有统计学意义的危险因素,再应用多因素非条件logistic回归分析患者CRS形成的独立危险因素.结果 单因素分析表明:患者性别、病种、穿刺部位、导管护理、导管用途与CRS差异无统计学意义,使用抗感染涂层导管与CRS呈负相关,为保护因素;多因素回归分析显示,导管留置时间[危险度比值比(OR)=2.682,95%可信区间(CI)为1.156～6.226,X2=5.275,P=0.022]、导管口径(OR=2.702,95%CI为1.183～6.175,X2=5.559,P=0.018)和白细胞计数(WBC)＜4×109/L(OR=1.371,95%CI 为1.044～1.800,X2=5.142,P=0.023),为CRS形成的独立危险因素.1100例中心静脉置管患者的总相关感染率为2.5%(28/1100).结论 CRS是院内菌血症的主要原因,影响感染的主要因素有导管留置时间、导管口径、患者年龄、穿刺次数、行TPN治疗.

Non-conditional logistic regression analysis on risk factors of central venous catheter-related infection

OBJECTIVE: To study the correlation of indwelling central venous catheter and systemic infection, to study the causative microorganisms and factors contributing to infections, and the diagnosis and treatment of such infection. METHODS: All the central venous catheters were produced by American or German companies. Subclavian vein, internal jugular vein, or femoral vein was chosen. Skin swab, blood in the catheter and peripheral blood were cultured. Clinical data including sex, age, disease, times of puncture, site of puncture, indwelling duration, type of catheter, caliber of catheter (single or double chamber, hemodialysis), nursing care, ways of use of the catheter were recorded, and they were subjected to non-conditional logistic regression analysis, then independent risk factors were determined with multivariate stepwise non-conditional logistic regression analysis. RESULTS: Unvaried non-conditional logistic regression analysis showed that sex, primary disease, site of puncture, nursing care, and ways of use of the catheter showed no correlation with CRS. Multivariate stepwise non-conditional logistic regression analysis showed that indwelling duration [odds ratio (OR)=2.682, 95% confidence interval (CI): 1.156-6.226,chi(2)=5.275, P=0.022], caliber of catheter (OR=2.702, 95%CI: 1.183-6.175, chi(2)=5.559, P=0.018) and white blood cell count (WBC)<4x10(9)/L (OR=1.371, 95%CI:1.044-1.800, chi(2)=5.142, P=0.023) were independent factors. The clinical study of 1 100 patients showed that the total correlated infection rate was 2.5% (28/1 100). CONCLUSION: Central venous catheterization is the major cause of bacteremia in hospital. The risk factors of infection are maintenance duration, location, and individual difference, and they are obviously correlated.