创伤行静脉留置导管患者血流感染病原菌分布及相关因素与预后研究  

Distribution of pathogens causing bloodstream infections in trauma patients undergoing intravenous catheter indwelling and related factors for prognosis

作　　者：徐雪飞[1] 吴霞云[1] 柴秀琴[2] 王舜尧[1] 黎萍[1] XU Xue-fei;WU Xia-yun;CHAI Xiu-qin;WANG Shun-yao;LI Ping(Quzhou People＇s Hospital,Quzhou,Zhejiang 324000,Chin)

机构地区：[1]浙江省衢州市人民医院重症监护室,浙江衢州324000 [2]浙江省衢州市人民医院呼吸内科,浙江衢州324000

出　　处：《中华医院感染学杂志》2018年第14期2124-2126,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生一般研究计划基金资助项目(2015KYA234)

摘　　要：目的探讨创伤行静脉留置导管抢救的危重患者血流感染的相关因素,为临床治疗提供参考。方法对医院2015年6月-2016年12月收治的104例创伤危重患者静脉置管抢救情况进行分析,患者均符合中心静脉导管感染诊断标准,采集创伤患者创口分泌物进行菌种鉴定,分析患者导管相关性血流感染发生的相关因素。结果 104例创伤危重患者中,颈内静脉置管32例,锁骨下静脉置管45例,股静脉置管27例。锁骨下静脉感染率低于股静脉和颈内静脉,差异有统计学意义(P<0.05),使用硅胶导管的患者感染率低于聚乙烯材质导管和聚氨基甲酸乙酯导管,置管<7d患者感染率低于置管>7d,单腔导管感染率低于多腔导管,差异有统计学意义(P<0.05),将单因素指标纳入Logistic回归分析可知置管部位、导管种类、置管时间及导管腔数为血流感染的独立影响因素;送检标本共分离病原菌128株,其中革兰阴性菌101株,占78.90%;革兰阳性菌16株,占12.50%;真菌11株,占8.59%。其中,革兰阴性菌以大肠埃希菌、肺炎克雷伯菌、产气肠杆菌为主;革兰阳性菌以粪肠球菌、屎肠球菌为主;真菌以白假丝酵母为主。结论重视创伤危重患者静脉留置导管的无菌操作、护理和监控,可以降低导管相关性血流感染的发生,降低创伤危重患者的病死率和致残率。OBJECTIVE To explore the related factors for bloodstream infections in critically ill patients undergoing intravenous catheter indwelling so as to provide guidance for clinical treatment.METHODS A total of 104 critically ill patients who received intravenous catheter indwelling for rescue from Jun 2015 to Dec 2016 were enrolled in the study,all of the patients were eligible for the criteria for diagnosis of central venous catheter-related infections.The wound secretions were collected from the patients,the isolated pathogens were identified,and the related factors for catheter-related bloodstream infections were analyzed.RESULTS Of the 104 critically ill trauma patients,32 were treated with internal jugular venous catheter indwelling,45 with subclavian venous catheter indwelling,and 27 with femoral venous catheter indwelling.The incidence rate of subclavian vein infection was lower than that of femoral vein infection and internal jugular vein infection,and there was significant difference（P〈0.05）.The infection rate was lower in the patients who used silicone catheters than in the patients who used polyethylene catheters and polyurethane catheters;the infection rate of the patients with catheter indwelling duration less than 7 days was lower than that of the patients with catheter indwelling duration more than 7 days,the incidence of single-lumen catheter-related infection was lower than that of multi-lumen catheter-related infection,and there was significant difference（P〈0.05）.Logistic regression analysis showed that catheter indwelling sites,types of catheter,catheter indwelling time and number of lumens were the independent influencing factors for the bloodstream infections.Totally 128 strains of pathogens were isolated from submitted specimens,101（78.90%）of which were gram-negative bacteria,16（12.50%）were gram-positive bacteria,and 11（8.59%）were fungi.Escherichia coli,Klebsiella pneumoniae and Enterobacter aerogenes were dominant among the gram-negative bacteria;Enterococcus faecalis an

关 键 词：创伤危重 血流感染 静脉置管 

分 类 号：R631[医药卫生—外科学]