头孢他啶治疗血透患者导管感染疗效观察  

Therapeutic Efficacy of Ceftazidime on Central Venous Catheter-related Infection in Patients with Hemodialysis

作　　者：第加美[1] 冯文[1] 袁玲[1] 万秀娟[1] 陈月圆[1] 李侠英[1] 陈秀[1] 刘智[1] 

机构地区：[1]安徽省淮南市第一人民医院血透室,232000

出　　处：《中华全科医学》2013年第6期879-880,共2页Chinese Journal of General Practice

摘　　要：目的探讨头孢他啶封管治疗血液透析患者中心静脉导管相关感染的疗效。方法 2009年1月-2011年12月在淮南市第一人民医院血液净化中心治疗的患者中有15例发生导管感染,其中1例感染发生于3周内,2例发生于置管后4周内,5周内发生导管感染者3例,在4～12个月发生感染的颈内静脉长期留置导管患者为9例。对感染患者均留导管血培养,于透析当日行置管口换药,血透后用普通肝素2 ml(12 500 IU)加生理盐水稀释至2.6 ml和头孢他啶1 g用4 ml的生理盐水稀释后抽取0.4 ml的稀释液混合,按照导管标明的量注入,连续封管2周,以后改为每周1次。1例糖尿病患者置管口皮肤红、肿、热、痛,有脓性分泌物,除按上述方法封管外,每天局部予以常规消毒处理后,外用2%莫匹罗欣软膏。结果在封管治疗1～2周后,15例导管感染者症状缓解,改为每周1次封管,连续2个月后,停止封管,连续观察5个月,未再发生感染。结论头孢他啶抗菌谱广,对大部分革兰氏阴性菌及金葡菌、表皮葡萄球菌等阳性菌有效。对中心静脉导管感染的血透患者采用头孢他啶封管治疗疗效显著。Objective To investigate clinical efficacy of catheter-sealed treatment with ceftazidime on central venous catheter- related infection in hemodialysis patients. Methods All 15 hemodialysis patients with central venous catheter related infection from 2009.1 to 2011.12 were enrolled in this study. 1 case was infected within 3 weeks after the indwelling catheter,2 cases with- in 4 weeks, 3 cases within 5 weeks, and 9 cases within 4 - 12 months （long term indwelling Jugular vein catheters）. The intravas- cular catheter blood culture specimens were analyzed in all infected patients. We changed dressings on the hemodialysis day, and sealed the catheters with Ceftazidime for 2 weeks at first, and then once time every week. 1 patient with diabetes experienced pain, heat, swelling and pain in the skin around the catheters, and produced purulent secretions, and received the routine local dis- infection treatment and external 2% mupirocin ointment. Results After catheter-sealed treatment with Ceftazidime for 1 - 2 weeks,the infection symptoms of 15 hemodialysis patients with central venous catheter related infection were relieved, and the sealing treatment was changed to one time every week. The catheter-sealed treatment was stopped one month later. The follow up of 5 months did not find infection case. Conclusion Broad spectrum of Ceftazidime is very effective to Gram-negative bacteria and Positive bacteria such as Staphylococcus aureus, Staphylococcus epidermidis. For hemodialysis patients with central venous catheter related infection,the efficacy of catheter-sealed treatment with Ceftazidime is very significant.

关 键 词：血液透析 头孢他啶 中心静脉导管感染 封管治疗 

分 类 号：R459.52[医药卫生—治疗学] R978.1[医药卫生—临床医学]