机构地区:[1]上海交通大学医学院附属瑞金医院血液科,上海2000250
出 处:《癌症进展》2020年第7期718-720,747,共4页Oncology Progress
摘 要:目的探讨急性淋巴细胞白血病化疗患者经外周静脉穿刺的中心静脉导管(PICC)导管相关性感染影响因素的Logistic回归分析。方法选取120例急性淋巴细胞白血病化疗患者,整理、分析所有患者病历资料,如性别、年龄、化疗次数、穿刺部位、穿刺次数、置管时间、糖尿病、免疫功能等,分析PICC导管相关性感染的危险因素进行单因素和Logistic回归分析,探讨感染危险因素,并提出预防对策。结果120例急性淋巴细胞白血病化疗患者中,PICC导管相关性感染17例,感染率为14.17%;共检出17株病原菌,其中革兰氏阴性菌占比58.82%,革兰氏阳性菌占比41.18%。不同性别、穿刺部位急性淋巴细胞白血病化疗患者PICC导管相关性感染发生率比较,差异均无统计学意义(P﹥0.05);不同年龄、化疗次数、置管时间、免疫功能情况、糖尿病情况急性淋巴细胞白血病化疗患者PICC导管相关性感染发生率比较,差异均有统计学意义(P﹤0.05)。Logistic回归分析结果显示,年龄≥65岁、化疗次数≥11次、置管时间≥11 h、免疫功能低下、有糖尿病史是急性淋巴细胞白血病化疗患者PICC导管相关性感染的独立危险因素(P﹤0.05)。结论年龄≥65岁、化疗次数≥11次、置管时间≥11 h、免疫功能低下、有糖尿病史是急性淋巴细胞白血病化疗患者PICC导管相关性感染的独立危险因素,临床治疗应该选择合适的化疗方案,缩短置管时间,针对危险因素积极采取预防措施,从而减少PICC导管感染发生。Objective To investigate the risk factors of peripherally inserted central catheter(PICC)-related infections in patients with acute lymphoblastic leukemia(ALL)undergoing chemotherapy by Logistic regression.Method The clinical data of 120 patients with ALL undergoing chemotherapy were retrospectively analyzed,to summarize related profiles including gender,age,chemotherapy cycles,puncture site,times of puncture,time of indwelling catheter,diabetes,and immune functions,etc.,among which the risk factors of PICC-related infection were included in univariate analysis and Logistic regression to evaluate their role in the development of infections,so as to propose preventive measures.Result PICC-related infection occurred in 18 of 120 patients with ALL,the infection rate was 14.17%.A total of 17 pathogenic bacteria were detected,of which 58.82%(10/17)were Gram-negative bacteria,and 41.18%(7/17)were Grampositive ones.Gender and puncture site were not related to the incidence of PICC-related infection(P>0.05);while age,chemotherapy cycles,times of puncture,time of catheterization,immune function and diabetes conditions were linked to PICC-related infection(P<0.05).Logistic regression indicated that,age(≥65 years old),chemotherapy cycles(≥11 cycles),time of indwelling catheter(≥11 hours),reduced immune function and prior history of diabetes were risk factors for PICC-related infection(P<0.05).Conclusion Age≥65 years old,chemotherapy cycles≥11 cycles,time of indwelling catheter≥11 h,low immune function and prior history of diabetes are independent risk factors for the incidence of PICCrelated infection in patients with acute lymphoblastic leukemia undergoing chemotherapy,necessitating the establishment of appropriate chemotherapy regimens,so as to shorten the time needed for indwelling catheter,and take active preventive measures against risk factors,consequently attaining the goal of reducing the incidence of PICC-related infections.
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