心脏术后中心静脉导管不同留置途径感染的观察及分析

目的观察中心静脉导管不同途径置管的感染率,探讨其相关危险因素及防治措施,为临床预防和减少导管相关性感染提供参考依据。方法对2009～2010年的198例心脏直视术后采取经股静脉、锁骨下静脉、外周静脉放置中心静脉导管,中心静脉导管尖端培养阳性患者的临床资料进行统计性分析。结果经锁骨下静脉途径的感染率为7.84%,经股静脉途径的感染率为23.61%,周围静脉感染率为6.89%,中心静脉管道的感染的病原菌中革兰氏阳性菌有12例,占57.1%;革兰氏阴性菌有8例,占38.1%;真菌1例,占4.8%。结论中心静脉导管感染率与不同留置途径具有不同程度差异,但股静脉穿刺途径和锁骨下静脉及周围静脉差异有统计学意义(P<0.05),中心静脉留置管道感染的致病菌以革兰氏阳性菌为主。

Infection Rate of Different Approach for Central Venous Catheter Placement after Cardiac Surgery

Objective To observe the infection rate of different approach for central venous catheter placement after cardiac surgery and explore the related risk factors,prevention and control measures,so as to provide references for the clinical preventive practices and reducing CVC-correlated infections.Methods The 198 cases of open heart surgery from 2009 to 2010 were enrolled in this study.They underwent the central venous catheter placement by approaches of femoral vein,subclavian vein or peripheral venous.The clinical materials of patients with a positive result of bacterial culture of the catheter tips were collected and analyzed with statistical techniques.Results The infection rates of subclavian vein,femoral vein,peripheral venous catheter-related were 7.84%,23.6% and 6.89%,respectively.Among the infectious pathogenic bacteria in central venous pipeline,there were 12 cases of gram-positive bacterium which account for 57.1%,8 cases of Gram-negative bacterium for 38.1% and 1 case of fungus for 4.8%.Conclusion The different degrees difference in the infection rates was founded among different approaches which the central venous catheter was placed.The differences between the puncture of femoral vein and subclavian vein or the peripheral vein are statistical significant(P<0.05).The gram-positive bacteria play a key role in the catheter-related infections.