血液病住院患者中心静脉置管与医院感染关系的病例对照研究  

Correlation of central venous catheterization with nosocomial infection in hematological inpatients: a case-control study

作　　者：郝静[1,2] 龙琦[1] 杨钰琴[3] 丁雪娇[3] 李雪[4] 杜欣[2] 孙爱华[2] 刘耀[2] 张曦[2] 周紫垣[1] 

机构地区：[1]第三军医大学军事预防医学院环境卫生教研室,重庆400038 [2]第三军医大学新桥医院血液科,重庆400037 [3]贵州医科大学公共卫生学院,贵阳550004 [4]成都中医药大学护理系,成都610075

出　　处：《第三军医大学学报》2016年第24期2634-2642,共9页Journal of Third Military Medical University

摘　　要：目的探讨中心静脉置管对血液科住院患者医院感染的影响。方法研究对象为2013年1月至2014年12月第三军医大学新桥医院血液科住院时间超过48h的全部住院患者。根据住院记录、护理记录和医院感染登记报告系统采集患者相关的临床、护理操作和医院感染相关资料。根据卫生部《医院感染诊断标准》将患者分为感染组和对照组，以非条件Logistic回归进行风险关联分析。结果纳入分析患者共7381例，住院期间发生医院感染的患者771例，采用中心静脉置管患者484例。对全部7381例患者和其中6026例血液系统肿瘤患者的分析结果十分接近，单因素分析结果显示中心静脉置管使医院感染风险显著增加（OR全部=6．66，95％CI：5．45～8．16；OR肿瘤=5．67，95％CI：4．59～6．99），但经多因素校正后关联均不显著（OR今部：1．14，OR肿瘤=1．16）。但在住院时间较长（≥28d）时，多因素分析结果显示中心静脉置管显著增加了医院感染风险（OR=1．60，95％CI：1．04～2．45），采用经外周静脉穿刺中心静脉置管方式（OR=1．71，95％CI：1．07—2．76）和以贵要静脉为穿刺部位时（OR=2．69，95％CI：1．44～5．02）均与医院感染有显著关联。住院时间长、粒细胞缺乏、使用糖皮质激素也与医院感染有显著关联。结论相对于其他危险因素，中心静脉置管使医院感染风险的增加在总体上不明显，但对长时间住院患者而言，中心静脉置管是相对独立的医院感染危险因素。Objective To determine the effect of central venous catheterization on nosocomial infection among the inpatients in hematological department. Methods All inpatients who were hospitalized in the hematological center of Xinqiao Hospital over 48 h during January 2013 and December 2014 were recruited in this study. Their data of treatment, nursing operation, and nosocomial infection were collected from the electronic medical record system and the nosocomial infection registration system. Nosocomial infection was diagnosed according to the Diagnostic Standard of Nosocomial Infection published by Ministry of Health of the P.R. China （2001）. Univatiate and multivariate logistic regression were used to evaluate the association between the risk of nosocomial infection and central venous catheterization. Results A total of 7 381 patients met the inclusion criteria, and of them, 6 026 cases was diagnosed as hematological malignancy, 771 cases was identified as nosocomial infection and 484 cases revived operation of central venous catheterization. The results were similar between the 7 381 patients and the 6 026 patients with hematological malignancy. Univariate analysis showed that central venous catheterization increased the risk of nosocomial infection （ OR,n = 6.66, 95% CI： 5.45 - 8.16 ; ORtumor = 5.67, 95% CI： 4.59 - 6.99 ）, but the association was not significant after adjustment for other risk factors （ ORan = 1. 14 ; ORt = 1.16）. However, among the patients with longer length of stay （LOS） （ ≥ 28 d）, multivariate analysis showed that central venous catheterization did increase higher risk of nosocomial infection （ OR = 1.60, 95% CI： 1.04 - 2. 45 ）, and the infection risk was also significantly increased in the patients undergoing peripherally inserted central catheters （ OR = 1.71, 95% CI： 1.07 - 2.76） and inserting the catheters from basilica vein （ OR = 2.69, 95% CI： 1.44 - 5.02）. Longer length of stay （ LOS）, agranulocytosis, and glucocorticosteroid were also signifi

关 键 词：血液病住院患者 中心静脉置管 医院感染 关联分析 

分 类 号：R181.32[医药卫生—流行病学] R473.6[医药卫生—公共卫生与预防医学]