心脏外科术后中心静脉导管相关感染致病菌及危险因素分析  

Central venous catheter related infection and risk factors after cardiovascular surgery

作　　者：唐闽[1] 崔岭[2] 时东彦[3] 梁宜武[1] 马千里[1] 王宪德[1] 

机构地区：[1]河北医科大学第二医院心脏外科,石家庄050001 [2]石家庄市第一医院急诊科 [3]河北医科大学第二医院细菌室,石家庄050001

出　　处：《中国综合临床》2008年第10期997-999,共3页Clinical Medicine of China

基　　金：河北省卫生厅科学基金资助项目（2005128）;石家庄市科技局科研立项（07146593）

摘　　要：目的研究心脏外科术后中心静脉导管相关感染（CRI），导管相关性菌血症（CRB）的发生率和菌群分布状况，以及CRI的危险因素，为临床科学管理中心静脉导管，降低CRI、CRB的发病率提供有益的参考。方法自2005年1月至2005年12月共随机选取在心脏外科手术治疗的300例患者留置的中心静脉导管进行尖端细菌培养，同时进行血培养。结果300例中35例（11．7％）发生CRI，CRB5例（1.7％）。病原菌菌群分布：革兰阳性球菌占54．3％，革兰阴性杆菌占34．3％，真菌占11．4％。前5位致病菌分别为：表皮葡萄球菌、金黄色葡萄球菌、肺炎克雷白杆菌、铜绿假单胞杆菌、白色念珠菌。CRI、GRB的危险因素包括：原发疾病种类、穿刺置管部位、中心静脉导管留置时间等。中心静脉导管留置时间〉6d，感染牟明显增加。结论CRI、CRB是留置中心静脉导管最严重的并发症，早期诊断、及时合理应用抗生素对降低病死率具有重要的意义。Objective To investigate the pathogen culturing of the catheter related infection（CRI） ,catheter related bloodstream infection（CRB） and risk factors after central venous catheter（CVC） of cardiovascular surgery in order to provide the beneficial reference. Methods From Jan 2005 to Dec 2005,a total of 300 cases central venous cathers were determined,and the cusp of the catheters was determined by bacteria cultivation,and blood bacteria cultivation. Results The infection happened in 35 of 300 patients with inserted central venous catheter. The cusps of GRI rate was 11.7% ,CRB rate was 1.7%. 54.3% pathogens were gram-positive cocci,34.3% were gramnegative bacilh ,11.4% were fungi. The most common strain were Staphylococcus epidermis, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aerurinosa, and Candiadia albicans. The infection rate increased obviously when the dwelling time 〉 6 d. Conclusion CRI and CRB are the most severe complication of GVC, and it is important to cut down the death with the early diagnosis and applying antibiotics rationally.

关 键 词：心脏外科手术 中心静脉导管 导管相关感染 

分 类 号：R472[医药卫生—护理学]