化疗患者经外周静脉置入中心静脉导管相关性感染危险因素分析  

Risk factors of catheter-related infections in peripherally inserted central catheterization in patients undergoing chemotherapy

作　　者：刘春[1] 青晓[1] 王小清[1] 粟超辉 LIU Chun;QING Xiao;WANG Xiaoqing;SU Chaohui(Department of Thyroid Gland and Breast Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China;Department of Burn,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China)

机构地区：[1]川北医学院附属医院甲状腺乳腺外科,四川南充6370000 [2]川北医学院附属医院烧伤科,四川南充6370000

出　　处：《癌症进展》2020年第5期523-525,536,共4页Oncology Progress

摘　　要：目的探讨化疗患者经外周静脉置入中心静脉导管(PICC)留置后导管相关性感染的危险因素。方法选取接受化疗且接受PICC治疗的260例患者为研究对象,记录患者PICC留置期间感染发生率,并进行病原菌分布检测,对PICC相关性感染的危险因素进行单因素分析以及多因素Logistic分析。结果260例患者中有35例患者发生PICC导管相关性感染,感染率为13.46%,其中局部感染率为65.71%(23/35),其次为血流感染28.57%(10/35),其他原因为5.71%(2/35)。35例发生PICC感染患者共分离出病原菌48株,病原菌分布依次为:金黄色葡萄球菌43.75%(21/48),表皮葡萄球菌27.08%(13/48),白色假丝酵母菌14.58%(7/48),鲍氏不动杆菌8.33%(4/48),肺炎克雷伯杆菌4.17%(2/48),其他葡萄球菌2.08%(1/48)。导管留置时间≥60 d、化疗疗程≥8次、外周血象异常、换药频次≥7 d、护士置管经验不足、免疫功能低下、有合并症是导致患者出现PICC相关性感染的独立危险因素(P﹤0.05)。结论化疗患者PICC导管相关性感染发生率较高,且受多种因素影响,需要结合危险因素以及患者自身情况给予合理的护理措施,以降低PICC留置期间感染率。Objective To explore the risk factors of peripherally inserted central catheter(PICC)-related infections in patients undergoing chemotherapy.Method A cohort consisted of 260 patients who received chemotherapy by PICC was retrospectively analyzed.The incidence of infection during indwelling PICC was recorded.The distribution of pathogens was detected.The risk factors of PICC-related infections were analyzed by univariate and multivariate Logistic analysis.Result Thirty-five out of 260 patients had developed PICC-related infection,amounting to anoverall infection rate of 13.46%,among those infected,local infection accounted for 65.71%(23/35),followed by bloodstream infection,totaling 28.57%(10/35),and infections of other causes corresponded to 5.71%(2/35).Forty-eight pathogenic bacteria were isolated from 35 patients with PICC infection,with staphylococcus aureus in 43.75%(21/48),staphylococcus epidermidis in 27.08%(13/48),and candida albicans in 14.58%(7/48),acinetobacter baumannii in 8.33%(4/48),klebsiella pneumoniae in 4.17%(2/48),and other staphylococcus which was observed in 2.08%(1/48).The risk factors of PICC-related infection including indwelling time≥60 d,courses of chemotherapy≥8,abnormal peripheral hemogram blood test results,frequency of dressing change≥7 d,nurses inexperience of catheterization,compromised immune function and presence of comorbidities(P<0.05).Conclusion The incidence of PICC-related infections in patients undergoing chemotherapy is high and influenced by many factors.It is necessary to administer appropriate nursing care interventions in consideration of risk factors and individual conditions to reduce the infection rate during PICC.

关 键 词：化疗 PICC导管 感染 危险因素 

分 类 号：R730.5[医药卫生—肿瘤]