大面积烧伤患者深静脉导管引发脓毒血症的影响因素分析  

Analysis of influencing factors of sepsis caused by deep venous catheter in large area burned patients

作　　者：罗增文[1] 余锋尤 李彩虹 LUO Zeng-wen;YU Feng-you;LI Cai-hong(ICU,Maoming People’s Hospital,Maoming 525000,China)

机构地区：[1]广东省茂名市人民医院外科ICU,525000

出　　处：《中国实用医药》2020年第26期23-25,共3页China Practical Medicine

摘　　要：目的探讨分析大面积烧伤患者深静脉导管引发脓毒血症的影响因素。方法选取50例大面积烧伤深静脉留置导管患者,按是否发生脓毒血症分为脓毒血症组(18例)和非脓毒血症组(32例)。对比两组患者的临床指标[性别、年龄、烧伤原因、烧伤体表总面积(TBSA)、深静脉导管留置时间、置管部位、置管部位皮肤条件、补液成分、有无吸入性损伤情况],并采用Logistic回归分析引发脓毒血症的影响因素。结果脓毒血症组患者的TBSA>60%、深静脉导管留置时间≥7 d、补液成分为高渗营养液、有吸入性损伤的占比分别为61.1%、88.9%、72.2%、77.8%,均明显高于非脓毒血症组的28.1%、59.4%、37.5%、31.3%,差异均具有统计学意义(P<0.05)。多因素Logistic回归分析显示:TBSA>60%、深静脉导管留置时间≥7d、补液成分为高渗营养液、有吸入性损伤是大面积烧伤患者深静脉导管引发脓毒血症的独立危险因素(P<0.05)。结论大面积烧伤患者深静脉导管引发脓毒血症的主要危险因素为TBSA>60%、深静脉导管留置时间≥7 d、输入高渗营养液及有吸入性损伤。在临床治疗的过程中,应当尽量缩短深静脉导管的留置时间和减少高渗营养液的输入,尤其是针对TBSA较大、合并有吸入性损伤的患者,要加强早期的抗感染干预,从而减少脓毒血症的发生。Objective To discuss and analyze the influencing factors of sepsis caused by deep venous catheter in large area burned patients.Methods A total of 50 cases of large area burned patients with deep venous catheter were divided into sepsis group(18 cases)and non-sepsis group(32 cases)according to whether sepsis occurred.The clinical indicators[gender,age,cause of burn,degree of total burn surface area(TBSA),indwelling time of deep venous catheter,catheterization site,skin condition of catheterization site,fluid replacement composition,presence or absence of inhalation injury]of the two groups was compared.Logistic regression analysis was used to analyze the influencing factors of sepsis.Results The proportion of TBSA degree>60%,indwelling time of deep venous catheter≥7 d,fluid replacement composition as hypertonic nutrient solution and inhalation injury of sepsis group was 61.1%,88.9%,72.2%and 77.8%,which was obviously higher than that of non-sepsis group 28.1%,59.4%,37.5%and 31.3%,and the difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that TBSA>60%,indwelling time of deep venous catheter≥7 d,fluid replacement composition as hypertonic nutrient solution and inhalation injury were independent risk factors for sepsis caused by deep venous catheter in large area burned patients(P<0.05).Conclusion The main risk factors of sepsis caused by deep venous catheter in large area burned patients are TBSA degree>60%,indwelling time of deep venous catheter≥7 d,infusion of hypertonic nutrient solution and inhalation injury.In the course of clinical treatment,the indwelling time of deep venous catheters should be shortened and the input of hypertonic nutrient solution should be reduced as much as possible.Especially for patients with large TBSA and inhalation injury,early anti-infection intervention should be strengthened to reduce the occurrence of sepsis.

关 键 词：大面积烧伤 深静脉导管 脓毒血症 影响因素 

分 类 号：R644[医药卫生—外科学] R459.7[医药卫生—临床医学]