小儿完全植入式静脉输液港导管相关性血流感染的诊治——附4例报道  

Diagnosis and treatment of catheter-related bloodstream infection of totally implantable venous access ports in children:a report of four cases

作　　者：黄一敏[1] 徐伟珏[1] 吴一波[1] 盛庆丰[1] 刘江斌[1] 吕志宝[1] Huang Yimin;Xu Weijue;Wu Yibo;Sheng Qingfeng;Liu Jiangbin;Lv Zhibao(Department of General Surgery,Shanghai Children's Hospital,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院,上海交通大学附属儿童医院普外科,上海市200062

出　　处：《临床小儿外科杂志》2020年第10期939-942,956,共5页Journal of Clinical Pediatric Surgery

摘　　要：目的总结小儿完全植入式静脉输液港(totally implantable venous access ports,TIVAPs)导管相关性血流感染(catheter-related bloodstream infection,CRBSI)的临床表现及治疗经验。方法回顾性分析2014年3月至2017年12月上海市儿童医院/上海交通大学附属儿童医院接受TIVAPs植入术的99例患儿临床资料,其中4例出现CRBSI的临床表现。4例患儿年龄分别为3个月、10个月(2例)和23个月。原发病分别为:短肠综合征1例、白血病2例、朗格汉斯细胞增多症1例。导管和外周静脉血培养结果为同一种细菌,根据细菌药敏试验,给予全身抗生素,辅以“抗菌锁”治疗,即配置高浓度敏感抗生素溶液,注入输液港港座及导管内并保留。治疗时长为8~10 d。结果3例患儿治疗后体温平稳,血培养转为阴性,TIVAPs继续留用。1例患儿经上述治疗,仍反复发热,血培养呈阳性,予拔除TIVAPs后感染控制。结论CRBSI是小儿TIVAPs较严重的并发症之一。通过全身抗生素及“抗菌锁”治疗,可以控制感染,若治疗无效,需拔除TIVAPs。Objective To summarize the clinical characteristics of catheter-related bloodstream infections(CRBSI)of totally implantable venous access ports(TIVAPs)in children.Methods A total of 99 patients successfully underwent TIVAPs implantation from March 2014 to December 2017.Four cases of CRBSI were retrospectively analyzed.The ages were 3,10,10 and 23 months respectively.The primary diseases were bowel syndrome(n=1),leukemia(n=2)and elevated Langerhans cell(n=1).Recurrent fever occurred at 3,4,7 and 9 months after TIVAPs implantation.Body temperature fluctuated between 38.7-39.5°C.The count of peripheral white blood cell was 1.8-14.9×10^9/L,The range of C-reactive protein(CRP)was 125-165 mg/L.The same species of bacteria(Staphylococcus aureus,Bacillus cereus,Agrobacterium tumefaciens&Achromobacter xylosoxidans)were detected in both TIVAPs and peripheral venous blood.According to the bacterial drug susceptibility test,systemic antibiotics were prescribed with an“antibacterial lock”.A high concentration of sensitive antibiotic was injected into TIVAPs for 8-10 days.Results After upper treatment,the temperature of 3 cases stabilized and blood culture turned into negative.TIVAPs were removed in one child with recurrent fever and repeated positivity of blood culture.Conclusion CRBSI is one of the most serious complications of TIVAPs in children.Systemic antibiotics and“antibacterial lock”may control CRBSI and avoid a removal of TIVAPs.

关 键 词：完全置入式静脉输液港 导管插入术 导管相关性感染 儿童 

分 类 号：R453.2[医药卫生—治疗学]