老年肿瘤患者PICC导管相关性感染的影响因素分析及干预评价  

Analysis and intervention evaluation of PICC catheter related infections in elderly tumor patients

作　　者：徐洪恩[1] 贾勇士[1] 吴树强[1] 吴颖[2] 高惠惠[3] 

机构地区：[1]浙江省人民医院放疗科,浙江杭州310014 [2]浙江省人民医院护理部 [3]浙江省人民医院医院感染管理科

出　　处：《中华全科医学》2016年第4期536-539,共4页Chinese Journal of General Practice

基　　金：浙江省中医药科学研究基金(2015ZA008)

摘　　要：目的分析老年肿瘤患者PICC导管相关性感染(PICC-RI)的危险因素,并提出针对性的干预策略。方法对自2013年1月—2015年9月在医院接受治疗并留置PICC导管的258例老年肿瘤患者的病历资料进行回顾性分析,分析PICC-RI的发生情况以及其危险因素。分析内容包括年龄(以70岁为界分组)、性别、季节(春秋/夏冬)、穿刺方式(直接/赛丁格穿刺)、留置时间(以7 d为界)、导管移动(有/无)、并发症(是/否)、周期性导管维护(有/无)、免疫功能(正常/低下)等因素,对上述因素进行单因素分析,通过多因素Logistic回归分析对差异具有统计学意义的单因素进行分析比较。结果共有31例患者出现术后PICC-RI,感染率为12.0%,分离出28株病原菌,革兰阴性菌16株(57.1%),革兰阳性菌11株(39.3%),真菌1株(3.6%);单因素分析显示,在导管移动、并发症、导管维护、穿刺方式、留置时间、季节、免疫功能等发面比较差异具有统计学意义(P<0.05),即夏冬季节、直接穿刺、有并发症、留置时间超过7 d、无周期性导管维护、免疫功能低下等危险因素可引起老年肿瘤患者PICC-RI发生,将以上因素进行进一步多因素Logistic回归分析,结果显示,夏冬季节、有导管移动、留置时间超过7 d、无周期性导管维护、免疫功能低下是老年肿瘤患者PICC-RI发生的独立危险因素。结论病原菌以革兰氏阴性菌为主,是老年肿瘤患者PICC-RI发生最主要的因素,同时感染发生同样和留置时间超过7 d、有导管移动、冬夏置管、无周期性导管维护及免疫功能低下等因素密切相关。Objective To analysis the risk factors of PICC catheter related infections（ PICC-RI） in elderly tumor patients,and put forward specific intervention strategies. Methods The 258 elderly tumor patients received treatment and indwelling PICC catheter in the hospital from January 2013 to September 2015 were selected,clinical data of the patients were retrospectively analyzed,the risk factors of PICC-RI were analyzed. Age,sex,season,puncture mode,retention time,catheter moving,complications,catheter maintenance,immune function and other factors were included,these factors were analyzed by univariate analysis,single factor which with statistically significant difference were multivariate Logistic regression analyzed. Results A total of 31 patients had postoperative PICC-RI,the PICC-RI rate was 12. 0%,28 pathogens were isolated,including 16 strains gram negative bacteria,accounting for 57. 1%,11 strains gram positive bacteria,accounting for 39. 3%,1 strains fungi,accounting for 3. 6%;univariate analysis showed that the difference of season,puncture method,catheter movement,concurrent diabetes,retention time,catheter maintenance,immune functionwere statistically significant（ P〈0. 05）,that is,the above factors were risk factors for PICC-RI in elderly tumor patients,further multivariate Logistic regression analysis to the above factors showed that season,catheter movement,catheter maintenance,retention time,immune function were independent risk factors for PICC-RI in elderly tumor patients. Conclusion G-bacteria were the main pathogens of infection for SSIin PICC-RI in elderly tumor patients,the occurrence of infectionis closely related to winter / summer catheter,catheter movement,longer retention time,no catheter maintenance and low immune function.

关 键 词：老年肿瘤 PICC导管相关性感染 危险因素 预防措施 

分 类 号：R730[医药卫生—肿瘤]