中心静脉导管相关血流感染的诊疗及防治对策  

Treatment and prevention of central venous catheter-related bloodstream infections

作　　者：周翠云[1] 高青[1] 陈惠清[1] 王世英[1] 

机构地区：[1]首都医科大学附属北京友谊医院感染管理科,北京100050

出　　处：《国际外科学杂志》2011年第1期12-14,共3页International Journal of Surgery

摘　　要：目的 从临床实用角度探讨中心静脉导管引发的导管相关性血流感染（CRBSI）的诊疗及防治,为进一步降低导管相关性血流感染发病率提供依据.方法 采用近5年国内外相关文献回顾与北京友谊医院监测结果及临床实际相结合的综合分析方法.结果 （1）从临床角度看,CRBSI原发的病原菌经由穿刺点/导管接头而侵入血流;继发的病原菌从其他感染灶入血后黏附在导管头上形成感染灶.（2）CRBSI诊治注意事项：①留置CVC患者,若出现不能用非感染原因解释的高热,要考虑到CRBSI的可能性;②普通导管和抗感染导管在引起感染的时间和病原学方面有不同之处;③抗感染导管的抗感染作用是有限的;④立即拔管是最有效的治疗措施;⑤穿刺点皮肤涂抹培养应淘汰.（3）CRBSI的防治：严格掌握CVC留置指征,选硅胶类导管,当置管时间超过5 d选择抗感染导管.结论 侵入性操作、长期置管及大量应用抗生素是引发CRBSI的易感因素.医院应建立一套完善的CRBSI的预防措施和操作流程,加强医护人员的教育培训,开展目标监测,以降低感染的发病率.Objective Focusing on the diagnosis, treatment and prevention of central venous catheter （CVC）-related bloodstream infections（CRBSI） in clinical practice, to provide clinical evidences for reducing the incidence of central venous catheter-related bloodstream infections Methods The related articles within the latest 5 years were reviewed, and the related monitoring data of the hospital were analyzed. Results （ 1 ）The pathogens of CRBSI invaded bloodstream through the puncture point/hub, and the pathogens of the secondary CRBSI came from the infections in other sites, invading bloodstream and adhering the catheter tip. （2）Highlights on the diagnosis of CRBSI： For the patients with CVC, the possibility of the CRBSI should be considered when severe fever not due to non-infectious causes occurred. Infection occurring time and pathogen are different between the general catheters and the anti-infective catheters. The effect of antiinfection of the anti-infective catheters are limited. To pull out the catheters is the most effective treatment measures. Routine puncture point culture should be rejected. （ 3 ） Prevention of CRBSI： The indications of CVC intubation should be undisputed. Silicone catheter should be used. The catheter should not be indwelled more than 5 days. Conclusions Invasive operation, the lasting time of catheterization and using a lot of antibiotics are the susceptible factors for CRBSI. Hospital should establish suite intervention methods and operation procedures,strengthen education of the medical staff and proceed with targeted monitor for decreasing the rate of infectious.

关 键 词：中心静脉导管 血流感染 诊断和治疗 预防 

分 类 号：R472[医药卫生—护理学]