去甲万古霉素-肝素冲洗预防中心静脉导管相关感染  

Prophylactic use of norvancomycin-heparin flushing for central venous catheter related infection

作　　者：周庆明[1] 杨秀芬[1] 王春玲[2] 赵立敏[1] 张征[2] 田惠玉[1] 

机构地区：[1]河北医科大学第一医院ICU,河北石家庄050031 [2]河北医科大学第一医院细菌室,河北石家庄050031

出　　处：《临床荟萃》2009年第11期935-937,共3页Clinical Focus

基　　金：河北省2008年医学科学研究重点课题计划(08280)

摘　　要：目的探讨去甲万古霉素-肝素冲洗预防中心静脉导管相关感染的效果。方法收集我院重症监护病房(ICU)患者67例、导管79根,导管留置时间均在3天以上。随机将患者分为治疗组和对照组。治疗组在肝素盐水冲洗或封管等常规护理基础上,用8g/L去甲万古霉素冲洗液3～5ml,每6小时冲洗静脉导管1次,冲洗时间最少5分钟;对照组采用肝素盐水冲洗或封管等常规护理。取导管血标本、导管尖端、外周血标本进行微生物的培养鉴定及药物敏感试验。结果两组67例共收集导管79根,共有20例患者的21根导管培养阳性,阳性率26.6%;共培养出21株致病菌,每1000根导管日感染数29。治疗组导管感染率低于对照组,分别为15.8%和36.6%(P=0.037);进一步分析发现治疗组球菌感染率明显低于对照组,分别为5.3%和21.9%(P=0.032);治疗组导管定植率低于对照组,分别为13.2%和34.1%(P=0.029);治疗组每1000根导管日感染数低于对照组,分别为16和42(P=0.001)。两组导管留置部位、胃肠外营养、导管平均留置时间等比较差异无统计学意义。结论去甲万古霉素-肝素冲洗技术可以有效降低表皮葡萄球菌和金黄色葡萄球菌等革兰阳性球菌导致的中心静脉导管相关感染,是一种有效、方便易行的临床新技术。Objective To investigate the effectiveness of prophylactic use of norvancomycin-heparin flushing for central venous catheter related infection. Methods 79 catheters（indwelling time〉3 d） from 67 cases admitted to ICU were collected and the patients were randomly divided into therapy group and control group. Catheters in therapy group received an aditional flushing with norvancomycin solution of 3--5 ml for at least 5 minutes every 6 hours on a basis care of flushing or block with heparin solution. The concentration of norvancomycin solution was 8 g/L. Catheters in control group received a regular care of flushing or block with heparin solution. Blood specimens from catheters and peripheral veins were collected as well as catheter tips for microbial cultivation,identification and drug sensitivity test. Results A total of 79 catheters from 67 cases were collected in two groups,in which 21 strains were isolated from 21 catheters in 20 cases. The infection rate was 26.6M and 29 per 1 000 catheters for a day. The infection rate in therapy group was 15.8% vs 36.6% in control group（ P =0. 037）. A further analysis revealed that the rate of infection with cocci in therapy group was lower than that in control group （5.3M vs 21.9M, P =0. 032）. The rate of colonization and infection rate per 1 000 catheters for a day in therapy group were also lower than those in control group （13.2% vs 34.1% P = 0. 029;16 vs 42 P = 0. 001）. As for the duration and the site of catheterization and parenteral nutrition, the two groups showed no statistical difference. Conclusion Application of norvancomycin-heparin flushing is an effective and easy-performing technique, which promises a reduction of infection rate with gram-positive cocci such as Staphylococcus epidermis and Staphylococcus aureus in central venous catheters.

关 键 词：感染 万古霉素 中心静脉导管 

分 类 号：R378[医药卫生—病原生物学]