颈内静脉穿刺皮下潜行固定预防开颅术后导管相关性血流感染  

Internal jugular vein subcutaneous undermining fixation in prevention of catheter-related blood stream infections after craniotomy

作　　者：卜文良 潘立东[2] 兰威[1] 赖卫平 

机构地区：[1]浙江省遂昌县人民医院神经外科,浙江遂昌县323300 [2]浙江省遂昌县人民医院麻醉科,浙江遂昌县323300

出　　处：《中华医院感染学杂志》2012年第24期5508-5510,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨颈内静脉穿刺留置中心静脉导管时应用皮下潜行改良固定法在降低重型颅脑损伤手术后气管切开患者中心静脉导管相关性血流感染(CRBSI)发病率中的有效性。方法 2009年10月-2011年9月共收治186例重型颅脑损伤手术后需行气管切开手术的患者,随机分为常规组和潜行组,每组93例,常规组颈内静脉穿刺留置中心静脉导管时采用常规方法穿刺和固定,潜行组采用皮下潜行改良方法穿刺和固定,分析比较两组的留置导管日及CRBSI发病率。结果常规固定组共留置导管日558d,平均留置导管日6.0d,CRBSI感染率为29.0%,皮下潜行固定组共留置导管日1674d,平均留置导管日18.0d,CRBSI感染率为8.6%,经卡方检验,差异均有统计学意义(P<0.05)。结论皮下潜行改良固定法行颈内静脉穿刺留置中心静脉导管可以降低重型颅脑损伤手术后气管切开患者的CRBSI发病率,方便气管切开患者的导管护理,延长中心静脉导管留置时间。OBJECTIVE To discuss the effectiveness of the modified undermining fixation during internal jugular vein puncture in reducing the morbility of catheter related bloodstream infections（CRBSI） among the patients with severe brain injuries after the surgery.METHODS From Oct 2009 to Sep 2011,a total of 186 patients with severe brain injuries who intended undergoing the tracheotomy were enrolled in the study and divided into the control group and the study group with 93 cases in each,the control group performed the internal jugular vein puncture for catheterization by using the conventional puncture and fixation,and the study group performed the puncture and fixation with the modified subcutaneous undermining fixation,the indwelling catheter days and the incidence of CRBSI between the two groups were compared and analyzed.RESULTS The total duration of catheterization in the control group was 558 days,the average duration of catheterization was 6.0 days,the incidence rate of CRBSI was 29.0%,the duration of catheterization in the study group was 1674 days,the average duration of catheterization was 18.0 days,the incidence rate of CRBSI was 8.6%,Chi square test showed that the differences were statistically significant（P0.05）.CONCLUSION The modified subcutaneous undermining fixation,as used for the internal jugular vein puncture for central venous catheterization,can reduce the incidence of CRBSI in the severe brain injury patients who underwent the tracheotomy,facilitate the catheter maintenance as well as prolong the duration of central venous catheterization.

关 键 词：颅脑损伤 气管切开 皮下潜行 中心静脉 血流感染 发病率 

分 类 号：R181.32[医药卫生—流行病学]