心脏外科患者中心静脉导管感染的相关因素及预防对策研究  

Related factors for central venous catheter-related infections in patients undergoing cardiac surgery and prevention countermeasures

作　　者：周丹[1] 陶凉[1] 刘彬[1] 周宏[1] 杨凯[1] ZHOU Dan TAO Liang LIU Bin ZHOU Hong YANG Kai(Wuhan Asian Heart Disease Hospital, Wuhan, Hubei 430022, Chin)

机构地区：[1]武汉亚洲心脏病医院心外科,湖北武汉430022

出　　处：《中华医院感染学杂志》2017年第7期1651-1654,共4页Chinese Journal of Nosocomiology

摘　　要：目的分析心脏术后中心静脉导管感染的原因,并探讨干预措施。方法选择2015年2月-2016年2月医院收治的心脏手术患者90例,术后均行中心静脉导管置管,分析全部患者临床资料,统计中心静脉导管感染率,讨论感染原因及干预措施。结果 90例中心静脉置管患者,中心静脉导管感染20例,感染率22.22%,共检出病原菌20株,革兰阴性菌6株占30.00%,革兰阳性菌13株占65.00%,真菌1株占5.00%;多因素Logistic回归分析结果显示,使用三腔导管、颈内静脉穿刺、置管时间>10d、有合并症是中心静脉导管感染的独立危险因素(P<0.05)。结论导致心脏术后中心静脉导管感染的原因较多,应针对危险因素术前应积极处理合并症,选择合理的导管种类、穿刺和封管方式,根据药敏试验科学使用抗菌药物,缩短置管时间,从而减少中心静脉导管感染风险,保障手术效果。OBJECTIVE To analyze the causes of central venous catheter-related infections after cardiac surgery and explore the intervention measures. METHODS A total of 90 patients who underwent the cardiac surgery in the hos- pital from Feb 2015 to Feb 2016 were enrolled in the study, and all of the enrolled patients received central venous catheterization after the surgery. The clinical data of all the patients were analyzed, the incidence of central venous catheter-related infections was statistically analyzed, and the causes of infections and intervention measures were explored. RESULTS Among 90 patients who received the central venous catheterization, 20＂ had central venous catheter-related infections, with the infection rate 22.22%. Totally 20 strains of pathogens were isolated, inclu- ding 6 （30. 00%） strains of gram-negative bacteria, 13 （65. 00%） strains of gram-positive bacteria, and 1 （5.00%） strain of fungus. The result of multivariate logistic regression analysis showed that the use of triple channel catheter, internal jugular vein puncture, catheter indwelling time more than 10 days, and complications （P 〈0. 05）. CONCLUSION There are a variety of causes of the central venous catheter-related infections. It is neces- sary to actively treat the complications aiming at the risk factors before the surgery, choose appropriate type of catheter and approaches of puncture and tube sealing, reasonably use antibiotics based on drug susceptibility tes- ting, and shorten the catheter indwelling time so as to reduce the risk of central venous catheter-related infections and ensure the surgical effect.

关 键 词：心脏手术 中心静脉导管感染 原因 干预措施 

分 类 号：R654.2[医药卫生—外科学]