深静脉置管相关性感染的研究  

Study on relationship of the correlative infection with deep vein indwelling catheterization

作　　者：韩蔚[1] 何瑾玢[1] 彭根英[1] 徐伟珍[1] 王蔚[1] 赵明红[1] 

机构地区：[1]浙江省丽水市人民医院,浙江丽水323000

出　　处：《护士进修杂志》2004年第9期781-783,共3页Journal of Nurses Training

摘　　要：目的探讨经皮穿刺深静脉置管术与导管相关性感染的因果关系。方法观察组深静脉置管术 2 0 9例 ,共采集标本 6 2 7例次作普通细菌培养 ,每例患者分别采集导管内外导管段各 5cm及对侧静脉血 10ml。对照组87例均系静脉给药住院患者 ,静脉给药时间 2～ 10周不等 ,静脉输液结束采血 10ml作普通细菌培养。结果深静脉放置时间愈长 ,则导管相关性感染机会愈多 ,随留置时间延长 ,相关性感染率依次增高 ,超过 8周者几乎 10 0 %感染(rs=0 9878,P <0 0 0 1) ,而深静脉置管术患者导管内外段细菌培养阳性率明显高于外周血液培养阳性率 (χ2 =19 5 ,P <0 0 0 5 ) ,深静脉留置导管内外段细菌培养病原体有表葡、腐葡、沃葡、粪链球菌和霉菌 ,但以G+ 球菌为绝对优势株 ,而导管内外段细菌培养阳性菌株符合率较高 ,提示导管相关性感染为外源性感染。对照组静脉血标本细菌培养结果以多数为G-需氧杆菌 ,说明非置管术患者以内源性感染为主 (χ2 =19 5 ,P <0 0 0 5 )。结论深静脉置管术相关性感染病原体主要来源皮肤正常寄殖菌 。Objective To study the relationship between transcutaneous indwelling catheter in deep vein and catheter correlative infection. Method 209 cases patients with catheterization in deep veins, among which 198 cases in cervical veins and 11 cases in thigh, were observed. Totally 627 specimen were collected for normal bacterial culture for each time. 5 cm tuber inside and outside the catheter as well as 10 mL blood from contralateral vein were collected. 87 cases as control group were all the in-patients with veinous injection for 2 to 10 weeks, from whom 10 mL blood were collected for normal bacterial culture. Result the longer the time of cathetering in deep vein will be the more the correlative infection will occur. With the times of catheterization prolongs, the correlative infection will increase by degree, 100 percent of infection will occur when it is over weeks (r s = 0.9878, P<0.001). the positive rate of infection inside and outside the catheter is significantly higher than that in peripheral vein. (χ 2=19.5,P< 0.005 ). Pathogen such as epidermidis staphylococcus, saprophyticus staphylococcus, warneri staphylocuccus, faecalis streptococcus and fungus can be found in specimen collected from inside and outside the catheter. Dominated by G + coccus with high positive correlative rate, these indicated that catheterization correlative infection can be extraneous infection. on the contrary, the control group is mostly represented with oxybiontic G -which indicating that non-catheterized cases are dominated by endogenous infection (χ 2=19.5, P<0.005). Conclusion Pathogen of catheterization correlative infections in deep vein mainly come from skin normal parasitism bacteria. Strictly local disinfection and shortening the time of indwelling catheterization will have important clinical significance in preventing the catheter correlative infection.

关 键 词：静脉置管术 感染 队列研究 

分 类 号：R472.9[医药卫生—护理学]