烧伤患者中心静脉导管相关性感染发生情况及其危险因素分析  

Analysis on the prevalence of central venous catheter-related infection in burn patients and its risk factors

作　　者：方利[1] 王凡[1] 孙珂岱 周涛[1] 龚雅利[1] 彭毅志[1] 

机构地区：[1]第三军医大学西南医院全军烧伤研究所,创伤、烧伤与复合伤国家重点实验室,重庆400038

出　　处：《中华烧伤杂志》2016年第4期243-248,共6页Chinese Journal of Burns

基　　金：卫生行业科研专项（201202002）;全军后勤科研计划重点项目（BWS11J039）;军队临床高新技术重大项目（2010gxjs068）

摘　　要：目的探讨烧伤患者中心静脉导管相关性感染（CRI）的发生情况及其危险因素，以指导临床实践。方法回顾性分析2011年6月-2014年12月笔者单位收治的符合人选标准的烧伤患者临床资料，共228例患者中心静脉置管480例次总计5026d。（1）统计各例次置管后患者CRI、导管相关性血流感染（CRBSI）发生情况（计算千日感染率）及其所致病死率、细菌检出情况。（2）根据性别、年龄、烧伤总面积、Ⅲ度面积、致伤原因、吸入性损伤程度、置管部位、是否经创面置管、置管持续时间进行分类，统计各例次置管后患者CRI发生情况，对数据行X2检验；选取差异有统计学意义的指标，行多因素logistic逐步回归分析，筛选患者发生CRI的独立危险因素。（3）分别针对所有置管例次、经创面置管例次，按不同置管持续时间分段，统计各时间段内各例次置管后患者CRI发生情况，对数据行x。检验、Fisher确切概率法检验，并进行Bonferroni校正。结果（1）CRI千日感染率为50．14％e（252／5026），所致病死率为3．51％（8／228）；CRBSI千日感染率为18．70％e（94／5026），所致病死率为2．19％（5／228）。CRI、CRBSI中分别检出病原菌319、105株，其中检出率居前4位的细菌均为鲍氏不动杆菌、铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌，主要真菌均为近平滑念珠菌。（2）不同性别、年龄、致伤原因、吸入性损伤程度、置管部位患者各例次置管后CRI发生情况比较，差异均无统计学意义（z。值为0．427～6．991，P值均大于0．05）。不同烧伤总面积、Ⅲ度面积、置管持续时间及是否经创面置管患者各例次置管后CRI发生情况比较，差异均有统计学意义（X2值为7．202～14．246，P〈0．05或P〈0．01）。（3）烧伤总面积、是否经创面置管、置管持续时间为患者发生CRI的独立危险因素（比值�Objective To investigate the prevalence of central venous catheter-related infection （CRI） in burn patients and its risk factors, so as to guide the clinical practice. Methods Clinical data of 5 026 days of 480 cases of central venous catheterization altogether in 228 burn patients admitted to our ward from June 2011 to December 2014, conforming to the study criteria, were retrospectively analyzed. （1） The incidence of CRI and that of catheter-related bloodstream infection （CRBSI） in patients （the infection rates per thousand days were calculated） and mortality due to them, and detection of concerning bacteria were recorded after each case of catheterization. （2） The incidence of CRI after each case of catheterization in patients was recorded according to the classification of their gender, age, total burn area, full-thickness burn area, cause of injury, severity of inhalation injury, location of catheterization, whether catheterization through wound or not, duration of catheterization, and the data were processed with ehi-square test. Indexes with statistically significant differences were selected, and they were processed with multivariate logistic stepwise regression analysis to screen the independent risk factors of CRI. （3） To all cases of catheterization and cases with catheterization through wound, incidence of CRI after each case of catheterization in patients at each time period was recorded according to the sorting of duration of catheterization. Data were processed with chi-square test and Fisher＇s exact test, and the values of P were adjusted by Bonferroni. Results （1） Infection rate of CRI per thousand days was 50. 14‰ （252/5 026）, resulting in the mortality rate of 3.51% （8/228）. Infection rate of CRBSI per thousand days was 18.70‰（94/5 026）, resulting in the mortality rate of 2.19% （5/228）. Respectively 319 and 105 strains of pathogens were detected in CRI and CRBSI, in which the top four bacteria detected were Acinetobacter baumannii, Pseudomonas a

关 键 词：烧伤 导管插入术 中心静脉 感染 危险因素 

分 类 号：R644[医药卫生—外科学]