神经外科患者中心静脉导管发生感染的危险因素分析

目的 探讨神经外科患者中心静脉导管发生感染的危险因素。 方法 回顾性分析温州医科大学附属第二医院2013年1月—2015年1月间收治的322例神经外科中心静脉置管患者的临床资料，依据是否出现感染症状将患者分为感染组和非感染组。收集2组患者以下资料:性别、年龄、导管留置位置(股静脉、锁骨下静脉、颈内静脉)、留置时间(3～6 d、7～14 d、15～31 d)、导管材质(柔韧、硬质)、导管皮肤交界处消毒方式(复合碘、聚维酮碘、2%葡萄糖酸氯己定)、导管管腔数(单腔、双腔)、输液种类(静脉营养液、普通液体)、导管接头(肝素帽、无针接头)、基础疾病(高血压性脑出血、颅脑损伤、急性脑栓塞、颅脑肿瘤)、血糖异常(有、无)、肝功能(正常、异常)指标，采用单因素和多因素Logistic回归分析对收集的指标进行分析，探讨影响神经外科患者中心静脉导管相关感染的影响因素。 结果 322例患者中31例(9.6%)患者发生中心静脉导管感染。单因素和多因素Logistic回归分析结果显示:年龄、导管留置位置、留置时间、导管材质、导管管腔数、输液种类、基础疾病、血糖异常、肝功能异常是神经外科患者中心静脉导管发生感染的危险因素。 结论 神外患者中心静脉导管易发生感染，其由多种因素共同作用引起，明确中心静脉导管感染的危险因素，利于进行针对性的护理，有效降低感染率。 

Risk factor analysis central venous catheter infection in neurosurgical patients

Objective To investigate the risk factors of central venous catheter infection in neurosurgical patients. Methods Total 322 cases of neurosurgery patients with central venous catheter in our hospital from January,2013 to January,2015 were retrospectively analyzed. Based on infection or not, patients were divided into infection group and non-infection group. The gender,age,catheter location(femoral vein,subclavian vein,internal jugular vein),retention time(3-6 d,7-14 d,15-31 d),catheter material (flexible,hard),junction disinfection (iodine compound,0.5% povidone iodine,2% chlorhexidine gluconate),catheter lumens number (single chamber,dual chamber),infusion type(intravenous nutrition,general liquid),parenteral nutrition input(yes or no),catheter connector(heparin cap,no pin connector),underlying diseases(hypertensive intracerebral hemorrhage,traumatic brain injury,acute cerebral embolism,brain tumors),glucose abnormalities(yes or no),liver function(normal or abnormal)of two groups were collected.The univariate and multivariate Logistic regression analysis were carried out to analysis the collected data to investigate the risk factors analysis of neurosurgical patients on infection of central venous catheter. Results In all 322 cases of patients,31 cases (9.6%) patients occurred central venous catheter infection.Univariate and multivariate Logistic regression analysis results showed that age,catheter location,indwelling time,catheter material,lumen catheter number,infusion types,input parenteral nutrition,underlying disease,glucose abnormalities,liver function abnormalities were the risk factors infection of central venous catheter in neurosurgical patients. Conclusion Neurosurgical patients easily occur central venous catheter infection.So clearing the risk factors of central venous catheter infection would be helpful for the targeted nursing and reducing the infection rates.