透析前Ⅰ型安尔碘浸泡血液透析导管盖子对导管相关性感染预防作用  

The infection prevention by soaking the catheter hubs in type Ⅰ entoiodine before hemodialysis sessions

作　　者：李洪[1] 黄杏[1] 陈冰[1] 梁让 曾欣[1] 蔡莉[1] 陈汝满 安娜[1] 冯海欢 LI Hong;HUANG Xing;CHEN Bing;LIANG Rang;ZENG Xin;CAI Li;CHEN Ru-man;AN Na;FENG Hai-huan(Blood Purification Center,Hainan Provincial Hospital,Haikou 570311,China;Medical Insurance Office of West China Hospital,Chengdu 610000,China)

机构地区：[1]海南省人民医院血液净化中心,海口570311 [2]华西医院医保办,成都610000

出　　处：《中国血液净化》2018年第8期542-548,共7页Chinese Journal of Blood Purification

摘　　要：目的前后对照,血液透析有隧道涤纶套导管(tunneled central venous catheter,TCC)使用前用Ⅰ型安尔碘浸泡盖子2年、不浸泡盖子2年,比较导管相关性感染(catheter related infection,CRI)发病率差异;同步体外研究常用消毒液对导管毁损情况。方法尿毒症维持透析3月以上,以TCC为维持透析通路者总共119名患者参与研究。2013年9月1日~2015年8月31日期间导管盖子用Ⅰ型安尔碘消毒液浸泡3~5min上机;同一批患者以及2015年以后新入患者、2015年9月~2017年8月30日予不泡盖子上机。详细记录导管相关性感染情况,每3月做CRI小结。导管毁损实验用导管:每组4条TCC,分别4种消毒液(75%酒精、Ⅰ型安尔碘、Ⅲ型安尔碘、洗必泰酒精)和生理盐水浸泡,每日观察导管毁损变化,每组有1只导管破损即终止实验。结果浸泡组:共37246导管日,出口感染17例,导管相关血液感染(catheter related blood infection,CRB)5例,隧道感染5例,可疑CRB 1例。非浸泡组:共35452导管日,出口感染61例,CRB12例,隧道感染4例。2组间各种导管相关性感染按照相应季度时间对比:第3季度出口感染率浸泡组显著低于不浸泡组(0.16/1000导管日比0.73/1000导管日,χ~2=5.524,P=0.019),并导致该季度浸泡组CRⅠ发生率比不浸泡组显著降低(0.40/1000导管日比0.65/1000导管日,χ~2=144.810,P<0.001);第4季度出口感染率浸泡组显著低于不浸泡组(0.06/1000导管日比0.50/1000导管日,χ~2=6.716,P=0.010),并导致浸泡组CRⅠ显著低于不浸泡组(0.06/1000导管日比0.65/1000导管日,χ~2=9.632,P=0.002);其他各亚种、各时间段感染率无差异。导管浸泡与否2年CRⅠ总感染率比较:出口感染率浸泡组显著低于无浸泡组(2.15/1000导管日比4.47/1000导管日,χ~2=16.211,P=0.001);隧道感染率浸泡组与不浸泡组无统计学差异(0.29/1000导管日比0.37/1000导管日,χ~2=0.308,P=0.741);总CRB浸泡组与不浸泡组无统计学差异(0.24/1000导管日比1.49/100Purpose The cap of tunneled central venous catheter（TCC） was soaked in type Ⅰ entoiodine for 3-5 min before use for 2 years and then was switched to routine care procedure without type I entoiodine treatment for 2 years. Catheter-related infection（CRI） was compared in the periods with and without type Ⅰ entoiodine treatment. Damage of TCCs by disinfectants was also studied. Methods A total of 119 maintenance hemodialysis patients using TCC as the blood access route for more than 3 months were enrolled in this study.During the period from Sept. 1st, 2013 to Aug. 31st, 2015, the catheter caps were soaked in type Ⅰ entoiodine for 3-5 min and then scrubbed with typeⅠentoiodine for 15-30 sec before connecting tubes. During the period from Sept. 1st, 2015 to Aug. 31st, 2017, the catheter caps of the same patients were treated with the same procedure but without type I entoiodine treatment. CRI was recorded and summarized every 3 months. In addi-tion, 5 groups of TCCs（4 TCCs/each group） were soaked in 75% alcohol, type Ⅰ entoiodine, type III entoiodine, chlorhexidine alcohol, and normal saline respectively, and observed every day until one of the TCCs was damaged. Results In the soaked group, there were totally 37,246 catheter days, in which exit infection in 17 cases, catheter-related blood infection（CRB） in 5 cases, tunnel infection in 5 cases, and suspected CRB in one case were detected. In non-soaked group, there were totally 35,452 catheter days, in which exit infection in 61 cases, CRB in 12 cases, and tunnel infection in 4 cases were detected. The comparisons of CRI according to seasons were made between the two groups. During the period from July to September, exit infections were lower in soaked group then in non-soaked group（0.16/1,000 catheter days vs. 0.73/1,000 catheter days, χ^2=5.524, P=0.019）, and CRIs were also lower in soaked group then in non-soaked group（0.40/1,000 catheter days vs. 0.65/1,000 catheter days, χ^2=144.810, P〈0.001）. During the period from October t

关 键 词：血液透析 带隧道带涤纶套导管 导管相关性感染 导管相关性血液感染 

分 类 号：R318.16[医药卫生—生物医学工程]