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050000 [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

出　　处：《陕西医学杂志》2009年第1期47-49,76,共4页Shaanxi Medical Journal

基　　金：河北省卫生厅科学基金资助项目(No2005128);石家庄市科技局科研项目(No07146593)

摘　　要：目的:研究心脏外科术后中心静脉导管(CVC)相关感染(CRI)、导管相关性菌血症(CRB)的发生率及菌群分布状况,及CRI的危险因素,为临床科学管理中心静脉导管,减少CRI、CRB的发病率提供参考。方法: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根中心静脉导管共培养出35例病原菌,CRI发生率11.7%;CRB5例,发生率1.7%。病原菌菌群分布为: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、肺炎克雷伯杆菌、铜绿假单胞杆菌、白色念珠菌。CRI、CRB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,感染率明显增加。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意义。Objective： To investigate the pathogen culturing of the CRI,CRB and risk factors after cardiovascular surgery in order to provide the beneficial reference for clinic. Methods： A total of 300 cases central venous cathers were determined,and the cusp of the catheters was determined by bacterial culture and blood bacterial culture. Results： The infection happened in 35 of 300 patients with inserted central venous catheter. The cusps of CRI rate was 11.47%, CRB rate was 1.7%. 54.3% pathogens were gram-positive cocci, 34. 3% were gram-negative bacilli, 11. 4% were fungi. The most common strain were Staphylococcus epidermis, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Candiadia albicans. The infection rate increased obviously when the dwelling time 〉6d. Conclusion： CRI,CRB are the most severitily complication of CVC, and it is important to cut down the death with the early diagnosis and applying antibiotics rationally.

关 键 词：感染/病因学 导管插入术 中心静脉导管 医原性疾病 心脏外科手术 手术后期间 危险因素 

分 类 号：R472.9[医药卫生—护理学] R183.9[医药卫生—临床医学]