长期深静脉留置透析导管相关性菌血症的分析  

Analysis of permanent indwelling hemodialysis catheter-related bacteremia

作　　者：黄俊[1] 刘日光[1] 张虹[2] 傅君舟[1] 

机构地区：[1]广州市第一人民医院肾内科,广东广州510180 [2]广州军区广州总医院肾脏内科,广东广州510010

出　　处：《中华医院感染学杂志》2012年第3期547-549,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨长期深静脉留置透析导管相关菌血症的发生率、危险因素及其预防治疗措施。方法选择长期深静脉留置透析导管的112例血液透析患者来自2007年1月-2010年10月广州市第一人民医院和广州军区广州总医院,回顾性分析发生导管相关菌血症患者的临床资料。结果 112例患者导管平均留置时间(11.3±6.9)个月,16例患者发生20例次导管相关菌血症,按导管日计算感染率为0.55例次/千导管日;高龄、有糖尿病、导管留置时间>12个月、血红蛋白低、血清白蛋白低和有菌血症史的患者导管相关性菌血症的发生率明显增加(P<0.05);常见病原菌有金黄色葡萄球菌、表皮葡萄球菌、阴沟肠杆菌、假单胞菌属等,分别占30.0%、20.0%、10.0%、10.0%。结论导管相关性菌血症是长期深静脉留置透析导管主要并发症之一,应特别关注有感染危险因素的患者;严格的无菌操作规范可减少菌血症的发生,联合抗菌药物治疗经导丝更换导管法可能是治疗导管相关性菌血症的最佳方法。OBJECTIVE To discuss the incidence and risk factors of the permanent indwelling hemodialysis catheter-related bacteremia in hemodialysis patients and the approach to their prevention and treatment. METHODS The study included 112 hemodialysis patients with permanent indwelling hemodialysis catheters from Jan.2007 and Oct.2010 in the first people＇s hospital of Guangzhou and Guangzhou general hospital of Guangzhou command of PLA.The clinical data of the patients who developed catheter-related bacteremia were retrospectively reviewed. RESULTS The average retention time of the indwelling catheters in the 112 hemodialysis patients was（11.3±6.9） months.Twenty cases of catheter-related bacteremia occurred in 16 patients.The overall incidence of bacteremic episodes was 0.55/1,000 catheter days.The bacteremic rates increased significantly in the patients with advanced age,diabetes,duration of catheter use more than 12 months,low hemoglobin,low albumin and previous history of bacteremia（P0.05）.The frequently isolated pathogenic bacteria included Staphylococcus aureus,S.epidermidis,Enterobacter cloacae and Pseudomonas,accounting for 30%,20%,10%,10%,respectively. CONCLUSION The catheter-related bacteremia is one of the main complications caused by permanent indwelling hemodialysis catheters.Particular attention should be paid to patients with risk factors.The strict aseptic rules for catheter handling can reduce catheter-related bacteremia.Using guide wire exchange of catheter combined with antibiotics is an optimal strategy of treatment.

关 键 词：肾透析 导管 长期 菌血症 

分 类 号：R181.32[医药卫生—流行病学]