血透用临时中心静脉置管相关感染的临床研究

目的探讨血液透析(血透)用临时中心静脉留置导管并发感染的相关因素及临床表现特征,寻求预防感染的有效措施。方法对104例建立中心静脉导管的血透患者进行观察。(1)对不同部位(颈内或锁骨下静脉组及股静脉组)置管的感染发生率进行比较分析。(2)对相同部位不同预防方法感染发生率的比较:从样本中筛取80例经颈内或锁骨下静脉途径的临时性中心静脉置管的患者,前期37例为对照组,采用常规措施预防导管感染;后期43例为试验组,使用抗生素多途径联合给药的试验方法,两组的感染率进行比较。结果 (1)常规预防感染方法的61例临时中心静脉导管中,共发生与静脉导管相关的感染12例(19.6%),股静脉置管感染发生率(29.2%)显著高于颈内及锁骨下静脉(13.5%)(P<0.05);(2)致病菌主要为葡萄球菌属和大肠杆菌属;(3)两组采用不同的预防感染方法感染率分别为13.5%和2.3%,其差异有统计学意义(P<0.05)。结论股静脉置管易发生感染,而抗生素多途径联合用药有助于降低感染率,延长置管后抗生素使用时间可能减少重新置管的几率。

An study of the catheter related infections in hemodialysis patients with temporary central vein catheter

Objective To analyze the catheter related infections in hemodialysis patients with temporary central vein catheter and search for the better control methods.Methods 104 patients with new hemodialysis catheters were enrolled into the study.1.The infection rate of cases of different parts catheter involved were comparative analyzed: femoral vein,internal jugular and subclavian vein.2.The infection rate of cases of same parts catheter involved were compared: 80 patients with temporary central vein catheter in internal jugular or subclavian vein were assigned to receive either traditional solution(37 cases at early stage) or antibiotics combined multiway solution(the later 43 cases).Data comparison of the catheter related infection incidence was performed between the two groups.Results 1.In the 61 cases of central vein catheter dealt with traditional solution,total infection incidence was 19.6%(12 cases).The rate of the femoral vein catheter infection(29.2%) was significantly higher than that of the internal jugular or subclavian vein(13.5%),(P<0.05).2.The main bacteria related were observed as staphylococcus and E.coli.3.Infection incidence in the traditional group and antibiotics combined multiway solution group were 13.5% and 2.3% respectively,the difference had statistical significance(P<0.05).Conclusion The femoral vein is not a good way to a hemodialysis patient who need a central vein catheter.The antibiotics combined multiway solution could be beneficial in control the infection incidence.Longer period the antibiotics applied to the patients with central vein catheter could decrease the chances of re-operations.