357例创伤失血性休克患者锁骨下静脉置管感染的危险因素分析  

Logistic regression analysis of risk factors in subclavian venous catheter-related infections of 357 patients with traumatic hemorrhagic shock

作　　者：周凯[1] 刘济滔[1] 胡沥[1] 钟武[1] 

机构地区：[1]四川省泸州医学院附属医院急诊科,四川泸州646000

出　　处：《中国中西医结合急救杂志》2015年第3期288-290,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：四川省医药卫生科研项目（130353）

摘　　要：目的分析造成失血性休克患者锁骨下静脉置管感染的危险因素，为感染防治提供依据。方法采用回顾性研究方法，选择四川省泸州医学院附属医院急诊科收治的357例行锁骨下静脉置管的失血性休克患者，按研究对象是否发生感染分为感染组（56例）和非感染组（301例）。收集患者的性别、年龄、基础疾病史、置管位置、导管留置时间、住院时间、抗菌药物使用情况、是否行气管切开、白细胞计数（WBC）水平等资料进行单因素分析；将有统计学意义的指标进行多因素logistic回归分析，筛选出影响创伤失血性休克患者锁骨下静脉置管感染的危险因素。结果357例失血性休克患者中，56例发生感染（占15．7％）。单因素分析显示：创伤失血性休克患者锁骨下静脉置管感染的危险因素包括年龄〉160岁（x2=19．839，P〈0．001）、既往糖尿病史（x2=6．252，P=O．012）、导管留置时间≥7d（x2=19．261，P〈0．001）、住院时间≥7d（x2=4．315，P=0．038）、抗菌药物使用时间≥7d（x2=16．161，P〈0．001）、行气管切开（x2=40．969，P〈0．001）、WBC〈4×109／L（x2=39．451，P〈0．001）、病情严重程度评分4—5分（x2=8．345，P=0．004）。多因素logistic回归分析显示：导管留置时间t〉7d[优势比（OR）值：16．713，95％可信区间（95％CI）为3．651～76．624]、行气管切开（OR=6．861，95％CI为2．377—18．246）、WBC〈4×109／L（OR=4．903，95％CI为1．887～12．643）是引起失血性休克患者锁骨下静脉置管感染的独立危险因素。结论严格执行无菌操作、缩短静脉置管时间、合理使用抗菌药物，可有效减少和避免导管相关性感染的发生。Objective To analyze the risk factors of subclavian venous catheter-related infections in patients with traumatic hemorrhagic shock （THS） and provide a basis for prevention and control of the infection. Methods A retrospective study was conducted. 357 patients with THS and indwelling of subclavian vein catheter admitted in the Department of Emergency of Affiliated Hospital of Siehuan Provincial Luzhou Medical College were enrolled, and according to the infection state, they were divided into infection group （56 cases） and non-infection group （301 cases）. The patients＇ data of gender, age, history of underlying disease, catheter position, catheter indwelling time, time staying in hospital, situation of antimicrobial drug used, application of tracheotomy or not, white blood cell count （WBC） levels, etc were collected for univariate analysis. The resulting indexes with statistical significance were applied for carrying out the multivariate logistic regression analysis, and then the independent risk factors involved in the development of subclavian venous catheter-related infections in the shock patients could be screened out, Results In 357 patients with THS, 56 were infected （15.7%）. Univariate analysis showed： age 1〉 60 years （X 2 = 19.839, P 〈 0.001）, with diabetes mellitus in past history （X 2 = 6.252, P = 0.012）, catheter indwelling time t〉 7 days （X 2 = 19.261, P 〈 0.001）, time staying in hospital i〉 7 days （X 2 = 4.315, P = 0.038）, time for use of antimicrobial drug/〉 7 days （X 2 = 16.161, P 〈 0.001）, tracheotomy （X 2 = 40.969, P 〈 0.001）, WBC 〈 4 x 109/L （X 2 = 39.451, P 〈 0.001） and the disease severity grade 4 - 5 （X 2 = 8.345, P = 0.004） were the risk factors of subclavian venous catheter-related infections in patients with THS. Multivariate analysis showed： catheter indwelling time /〉 7 day [odds ratio （OR） = 16.713, 95% confidence interval （95%C/） 3.651 - 76.624）, traeheotomy （OR = 6.861, 95%CI 2.377 - 18.246）,

关 键 词：锁骨下静脉置管 创伤 休克 失血性 感染 危险因素 

分 类 号：R472.9[医药卫生—护理学]