重症监护室患者中心静脉导管相关性血流感染现状及危险因素meta分析

  目的  分析ICU患者导管相关性感染的危险因素。  方法  检索PubMed、Web of Science、Cochrane Library、CNKI、万方、CBM、EBSCO等数据库中有关ICU患者中心静脉导管相关性血流感染独立危险因素的相关文章，合并结局指标并使用RevMan 5.3软件进行meta分析。  结果  纳入13篇文献，共12 283例患者，出现感染的人数为773例，感染发生率为6.29%。危险因素共9项，包括导管留置时间≥7 d(OR=5.30，95% CI:3.39~8.27)、合并糖尿病(OR=21.15，95% CI:11.45~39.08)、置管前使用抗生素(OR=6.63，95% CI:5.12~8.58)、高龄(OR=3.01，95% CI:2.74~3.31)、穿刺次数＞2次(OR=60.10，95% CI:30.63~117.94)、APACHEⅡ评分较高(OR=16.07，95% CI:8.97~28.77)、股静脉置管(OR=12.41，95% CI:3.82~40.30)、男性(OR=7.93，95% CI:3.69~17.04)、经历过急诊手术(OR=8.12，95% CI:3.43~19.19), 均P＜0.05。  结论  导管留置时间≥7 d、患者合并糖尿病、置管前使用抗生素、患者年龄＞55岁、置管次数＞2次、APACHEⅡ评分较高、选择股静脉为留置部位、男性、经历过急诊手术是ICU患者发生中心导管相关性血流感染的主要危险因素。临床上应重视高危人群和相关危险因素，采取有效的干预措施，减少中心静脉导管相关性血流感染的发生。 

A meta-analysis of status and risk factors of central venous catheter-associated bloodstream infection in ICU patients

  Objective  To analyse the risk factors of catheter-related infection in ICU patients.  Methods  Related articles on independent risk factors of central venous catheter-related bloodstream infection in ICU patients were searched in PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, CBM, EBSCO and other databases. Outcomes were combined, and meta-analysis and sensitivity analysis were performed using RevMan 5.3 software.  Results  A total of 13 studies were included, including 12 283 patients and 773 infected patients. The infection rate was 6.29%. Nine risk factors were as follow: catheter indwelling days ≥7 days (OR=5.30, 95% CI: 3.39-8.27), diabetes mellitus (OR=21.15, 95% CI: 11.45-39.08), antibiotic use before catheterisation (OR=6.63, 95% CI: 5.12-8.58), advanced age (OR=3.01, 95% CI: 2.74-3.31), puncture frequency of >2 times (OR=60.10, 95% CI: 30.63-117.94), high APACHEⅡ score (OR=16.07, 95% CI: 8.97-28.77), femoral vein catheterisation (OR=12.41, 95% CI: 3.82-40.30), male (OR=7.93, 95% CI: 3.69-17.04), emergency surgery (OR=8.12, 95% CI: 3.43-19.19), all P < 0.05.  Conclusions  The main risk factors for central catheter-related bloodstream infection in ICU patients are catheter indwelling days ≥7 days, diabetes mellitus, antibiotics before catheterisation, age of > 55 years, catheterisation frequecy of >2 times, high APACHEⅡ score, femoral vein as the indwelling site, male and emergency surgery. Clinical attention should be paid to high-risk groups and related risk factors, and effective intervention measures should be taken to reduce the occurrence of central catheter-related bloodstream infection.