某三甲医院白血病患者化疗期间中心静脉置管诱发感染因素及PDCA干预效果  

The factors of infection induced by during chemotherapy in leukemia patients and the PDCA intervention in a top three hospital

作　　者：朱莉萍[1] 孙舒君[1] 潘杰伟 胡金莲 周凯捷 朱晟 ZHU Li-ping;SUN Shu-jun;PAN Jie-wei;HU Jin-lian;ZHOU Kai-jie;ZHU Cheng(Hematology Department,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai200020,China)

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200020

出　　处：《医学动物防制》2021年第3期205-209,共5页Journal of Medical Pest Control

基　　金：国家自然科学基金(81970148)。

摘　　要：目的研究上海市某三甲医院白血病患者化疗期间中心静脉置管诱发感染的因素分析及计划-执行-检查-总结循环(plan-do-check-action cycle,PDCA)干预的效果。方法选取2016年1-12月期间某院收治的103例白血病化疗治疗患者为研究对象,依据患者感染与否将其分为感染组和非感染组,收集两组患者的基础资料、临床资料及各项检查指标,采用单因素分析和多因素Logistic回归分析探讨影响患者治疗期间中心静脉置管诱发感染的危险因素,并针对感染患者佐以PDCA干预,观察其对感染患者的干预效果。结果经调查分析显示,103例白血病化疗患者中,中心静脉置管诱发感染患者34例,感染发生率为33.01%。经单因素分析显示,感染组与非感染组患者的年龄、性别、体质指数(body mass index,BMI)、吸烟史、饮酒史、感染史、基础疾病、置管位置等因素其差异均无统计学意义(P>0.05),而两组患者在置管时间、置管次数、预防性使用抗菌药、皮肤局部感染等方面其差异均有统计学意义(P<0.05),且感染组置管时间、置管次数、未预防性使用抗菌药、皮肤局部感染发生率均高于非感染组。Logistic回归分析显示,置管时间长、置管次数多、未预防性使用抗菌药、皮肤局部感染是白血病患者化疗期间中心静脉置管诱发感染的独立危险因素。感染组患者经PDCA干预后患者感染症状得到显著控制,患者体温、白血病计数、C反应蛋白(C-reactive protein,CRP)水平显著低于治疗前,差异有统计学意义(P<0.05)。结论某院白血病患者化疗期间中心静脉置管有较高的感染发生率,主要受到置管时间长、置管次数多、未预防性使用抗菌药、皮肤局部感染等危险因素的诱发,采用PDCA干预治疗能够有效缓解患者的感染症状。Objective The current analysis was set to study the factor analysis of peripherally inserted central catheter in leukemia patients during chemotherapy and the effect of plan-do-check-action cycle(PDCA) intervention in a 3 A hospital in Shanghai.Methods A total of 103 patients with leukemia treated by chemotherapy in the hospital from January to December 2016 were selected as the research object,and divided into infected and non-infected groups.The basic data,clinical data,and various examination indexes of patients in the two groups were collected.The risk factors affecting the infection induced by peripherally inserted centralr catheter during treatment were explored using univariate analysis and multivariate Logistic regression analysis.Besides,PDCA intervention for infected patients was used to observe the effect of the intervention on infected patients.Results According to the investigation and analysis,there were 34 cases of peripherally inserted central catheter-induced infection among 103 leukemia chemotherapy patients,the incidence of infection was 33.01%.Univariate analysis showed that there were no significant differences in such factors as age,gender,body mass index(BMI),smoking history,drinking history,infection history,basic diseases,catheterization position between the infection group and the non-infection group(P>0.05).However,there were significant differences in catheterization time,times of catheterization,prophylactic use of antibiotics,and local skin infection between the two groups(P<0.05).The catheterization time,times of catheterization,non-prophylactic use of antibiotics,and the incidence of local skin infection in the infected group were higher than those in the non-infected group.Logistic regression analysis showed that long catheterization time,multiple catheterization times,non-prophylactic use of antibiotics,and local skin infection were the independent risk factors for the infection induced by peripherally inserted centralr catheter in leukemia patients during chemotherapy.After PDCA

关 键 词：白血病 化疗治疗 中心静脉置管 感染 危险因素 

分 类 号：R733.7[医药卫生—肿瘤]