血液透析患者导管相关性血流感染风险评估研究  

Risk assessment of catheter-related bloodstream infections in patients with hemodialysis

作　　者：张丽萍[1] 付阿丹[1] 朱江[1] 刘昌璇[1] 陈文莉[1] 

机构地区：[1]武汉市中心医院血液透析室,湖北武汉430014

出　　处：《中华医院感染学杂志》2015年第23期5421-5423,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81400734)

摘　　要：目的探讨预防透析患者导管相关性血流感染的风险评估方法,并根据风险评估结果制定干预措施,以减少感染的发生率。方法选取2013年3月-2015年4月医院收治的312例血液透析患者为研究对象,调查透析患者导管相关性血流感染的发生率,分析相关危险因素,数据采用SPSS 16.0软件进行统计分析。结果 312例采用颈内静脉或股静脉置管的血液透析患者中30例发生了导管相关性血流感染,发生率为9.62%;共检出病原菌38株,以金黄色葡萄球菌及表皮葡萄球菌最多见,分别占34.21%及21.05%;患者年龄>60岁、采用股静脉穿刺、置管次数≥3次、留置导管时间>15d、血清白蛋白水平<40g/L及合并糖尿病是透析患者发生导管相关性血流感染的危险因素(P<0.05)。结论对中心静脉置管的血液透析患者进行导管相关性血流感染的专项风险评估并及时干预,能够有效降低导管相关性血流感染的发生。OBJECTIVE To explore evidence-based risk assessment of catheter related bloodstream infections （CRB- SI） prevention in hemodialysis patients and the effect of clinical intervention according to the assessment results, so as to reduce the incidence of infections. METHODS Totally 312 cases of hemodialysis patients, admitted from Mar. 2013 to Apr. 2015 in our hospital, were selected for this study. Members of CRBSI team used the risk as- sessment scale for quality control and intervention in hemodialysis patients. The incidence of catheter-related bloodstream infections was observed and the related risk factors were analyzed. All data were statistically analyzed by SPSS 16.0. RESULTS Among 312 hemodialysis patients with internal carotid or femoral vein catheterization, catheter-related bloodstream infections occurred in 30 cases, accounting for 9.62 %. Among 38 isolated strains of pathogens bacteria, Staphylococcus aureus and Staphy[ococcus epiderrnidis were the most common ones, account- ing for 34.21% and 21.05% respectively. Age〉 60 years, the use of the femoral vein puncture, intubation times ≥3 times, indwelling catheter time〉 15 d, albumin level 〈40g/L and diabetes were risk factors for dialysis pa- tients with catheter-related bloodstream infections. CONCLUSION Specific risk assessments of catheter-related bloodstream infections and timely interventions can effectively reduce the incidence of catheter-related bloodstream infections in hemodialysis patients with central venous catheter.

关 键 词：血液透析 导管相关性血流感染 中心静脉导管 风险评估 

分 类 号：R181.32[医药卫生—流行病学]