中心静脉营养引起的导管性败血症  

Catheter related sepsis secondary to central venous nutrition

作　　者：吴海福[1] 许剑民[1] 靳大勇[1] 吴肇汉[1] 

机构地区：[1]上海医科大学中山医院外科

出　　处：《肠外与肠内营养》1999年第1期19-22,共4页Parenteral & Enteral Nutrition

摘　　要：目的：了解导管性败血症（ＣＲＳ）的菌群变迁及药敏情况，以及可能导致ＣＲＳ的危险因素。方法：对１９９３年２月至１９９７年１２月期间在上海医科大学中山医院外科发生中心静脉营养导管性败血症的３９例病人作回顾性调查分析。结果：提示ＣＲＳ最常见的病原体是金黄色葡萄球菌，其次为表皮葡萄球菌、鲍曼不动杆菌、阴沟肠杆菌、硝酸盐阴性杆菌、微球菌和真菌。大多数细菌均有较高程度的耐药性，革兰阳性球菌对去甲万古霉素的敏感率达９０．９％，革兰阴性杆菌对阿米卡星及头孢他啶的敏感率分别为５４．２％和５２．１％。结论：可能导致ＣＲＳ的危险因素为：①皮肤有破损；②气管切开术；③合并有感染性疾病者；④严重的原发病；⑤急性胰腺炎。ＣＲＳ的有效处理方法是拔除感染的导管。Objectives:To study bacterial change and drug sensitivity of catheter related sepsis(CRS),and possible risk factors which cause CRS. Methods:Between February 1993 and December 1997,39 patients with central venous nutrition CRS were studied retrospectively at our hospital. Results:The most common organisms were staphylococcus aureus and staphylococcus epidermidis.The bacteremic pathogens isolated in this study demonstrated a marked pattern of antibiotic resistance,Gram positive coccis were sensitive to vancomycin with a sensitivity rate of 91.5%,gram negative bacillis were sensitive to amikacin and ceftazidine with sensitivity rate of 54.2% and 52.1% respectively. Conclusions:Possible risk factors which cause CRS:①Breakdown of skin integrity;②Tracheotomy;③Preexisting infection(urinary of respiratory tract,peritoneal cavity,wound,etc);④severe underlying illnesses(all intensive care unit patients);⑤acute pancreatitis.The effective treatment of catheter related sepsis is removal of infected catheters.Vancomycin or/and amikacin may be first chosen to treat CRS.

关 键 词：中心静脉营养 导管性 败血症 危险因素 治疗 

分 类 号：R459.3[医药卫生—治疗学] R631.302[医药卫生—临床医学]