血液透析患者中心静脉置管的感染因素分析及对策

目的分析血液透析患者中心静脉置管的感染因素分析及对策。方法医院2009年7月-2011年6月共行中心静脉置管术112例,对其发生感染患者进行分析。结果 112例行中心静脉置管术患者中,22例发生医院感染,感染率为19.6%;股静脉感染率为21.9%,稍高于颈内静脉的17.1%及锁骨下静脉的15.4%,然而感染率差异无统计学意义;置管<10d患者的感染率为11.5%,低于置管10～20、>20d患者的17.4%及27.5%,差异有统计学意义(P<0.05);糖尿病肾病患者的感染率为31.6%,显著高于其他基础疾病(P<0.05);中心静脉置管血流通畅患者感染率为17.9%,血流不通畅感染率为22.2%,差异无统计学意义。结论为减少感染发生,首选颈内静脉或锁骨下静脉置管应作为中心静脉置管的部位,尽可能缩短导管留置时间;要严格无菌操作,提高护理质量能有效预防感染发生。

Causes and prevention of central venous catheter-related infections in hemodialysis patients

OBJECTIVE To study the causes and prevention of central venous catheter-related infections in hemodialysis patients.METHODS A total of 112 patients who underwent central venous catheterization from Jul 2009 to Jun 2011 were selected,the causes of the infections in those patients were analyzed.RESULTS Of 112 patients who underwent central venous catheterization,nosocomial infections occurred in 22 cases with the infection rate of 19.6%;the rate of femoral vein infection was 21.9%,slightly higher than 17.1% of the internal jugular vein infection and 15.4% of the subclavian vein infection,the difference was not statistically significant;the infection rate of the patients with the catheterization duration less than 10 days was 11.5%,lower than 17.4% of the patients with 10-20 days and 27.5% of the patients with more than 20 days,the difference was statistically significant(P<0.05);the infection rate of the patients with diabetes was 31.6%,significantly higher than that of the patients with other underlying diseases(P<0.05);the infection rate of the patients with smooth blood flow was 17.9%,the patients without smooth blood flow 22.2%,the difference was not statistically significant.CONCLUSION In order to reduce infection,it is preferred use of internal jugular vein or subclavian vein catheterization as the site of central venous catheterization;to shorten the duration of indwelling catheter,strictly conduct the aseptic operation,and improve the quality of nursing can contribute the effective prevention of nosocomial infections.