胃肠外科术后中心静脉导管相关感染危险因素分析及3种固定方式的比较  

Risk factors for peripherally inserted central venous catheter-related infection after gastrointestinal surgery and three types of fixation methods

作　　者：许祖存 齐华英[1] 王申[1] 胡新春 郭桐欣 XU Zu-cun;QI Hua-ying;WANG Shen;HU Xin-chun;GUO Tong-xin(Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院普通外科,天津300192

出　　处：《中华医院感染学杂志》2018年第22期3450-3453,共4页Chinese Journal of Nosocomiology

基　　金：天津市卫计委青年基金资助项目(2016Y0199)

摘　　要：目的探讨胃肠外科术后中心静脉导管(PICC)相关感染危险因素分析及3种固定方式的优劣。方法选择2012年1月-2016年10月本院胃肠外科术后进行PICC植入的305例患者为研究对象,根据PICC管固定方法分为胶条固定法110例(A组)、缝线固定法105例(B组)、思乐扣固定法90例(C组)。比较各组导管移位/脱出结果、不良反应发生情况、疼痛评分。统计发生PICC导管相关感染病例,并进行PICC导管相关感染单因素及多因素Logestic回归分析。结果各组导管移位比率、移位距离、移位次数、导管脱出比率无统计学差异。A、B组皮肤过敏发生率明显低于C组,经比较差异有统计学意义(P<0.05)。B组疼痛评分明显高于A、C组,C组疼痛评分明显高于A组(P<0.05)。logistic回归分析显示导管移动、免疫机能、导管维护周期、导管穿刺技术为PICC导管相关感染发生的危险因素(P<0.05)。在固定方式有效性方面,缝线固定法有明显优势;在固定方式安全性方面,胶条固定法明显优于其他两组;在固定方式使用体验方面,思乐扣固定法更佳。结论防止导管移动、提高患者免疫机能、及时维护导管、提高穿刺技术可降低导管相关感染。用胶条固定效果最好。OBJECTIVE To explore the risk factors for peripherally inserted central venous catheter（PICC）-related infection after gastrointestinal surgery and observe the advantages and disadvantages of the three types of fixation methods.METHODS From Jan 2012 to Oct 2016,a total of 305 patients who were treated with PICC after the gastrointestinal surgery were recruited as the study objects and divided into the adhesive tape fixation group（group A）with 110 cases,the sutured fixation group（group B）with 105 cases and the Sirol buckle fixation group with90 cases（group C）according to the fixation method of PICC.The incidence rates of displacement/prolapse,adverse reactions and pain score were observed and compared among the three groups,the patients who had the PICC-related infection were statistically analyzed,and the univariate analysis and multivariate logistic regression analysis were performed for the PICC-related infection.RESULTS There were no significant differences in the rate of displacement of catheter,distance of displacement,number of times of displacement and rate of prolapse of catheter among the three groups.The incidence of skin allergy was significantly lower in the group A and the group B than in the group C（P〈0.05）.The pain score of the group B was significantly higher than that of the group A and the group C,and the pain score of the group C was significantly higher than that of the group A（P〈0.05）.The result of the logistic regression analysis indicated that the displacement of catheter,immune function,maintenance cycle of catheter and puncture technique were the risk factors for the PICC-related infection（P〈0.05）.In terms of the effectiveness of fixation,the sutured fixation method had obvious advantages;in terms of the safety of fixation,the adhesive tape fixation was obviously superior to the other two fixation methods;in terms of the experience of fixation,the Sirol buckle fixation was better.CONCLUSIONIt is an effective way to prevent the displacement of catheter,boos

关 键 词：经外周静脉穿刺中心静脉置管术 导管相关感染 胃肠外科 危险因素 

分 类 号：R656[医药卫生—外科学]