早产儿经外周中心静脉置管敷料更换频率安全性的随机对照研究  

Safety of PICC dressing replacement frequency in premature infants:a randomized controlled study

作　　者：高锦华 吴佳音 邓素芬 林育敏 周燕梅 赵晓燕 李婷婷[1] Gao Jinhua;Wu Jiayin;Deng Sufen;Lin Yumin;Zhou Yanmei;Zhao Xiaoyan;Li Tingting(Department of Neonatology,Women and Children's Hospital of Xiamen University,Xiamen 361003,China;Department of Clinical Laboratory,Women and Children's Hospital of Xiamen University,Xiamen 361003,China)

机构地区：[1]厦门大学附属妇女儿童医院/厦门市妇幼保健院新生儿科,361003 [2]厦门大学附属妇女儿童医院/厦门市妇幼保健院医学检验科,361003

出　　处：《中华新生儿科杂志（中英文）》2021年第6期33-37,共5页Chinese Journal of Neonatology

基　　金：厦门市科技计划立项资助项目(3502Z20174022)。

摘　　要：目的探讨早产儿经外周中心静脉置管(peripherally inserted central catheter,PICC)敷料更换频率延长至14 d内按需更换的安全性。方法选取2017年6月至2020年2月在厦门大学附属妇女儿童医院新生儿科行PICC的早产儿进行前瞻性随机对照研究,通过在线随机软件将入选早产儿分为7 d、11 d、14 d更换敷料组,3组均采用聚氨酯透明敷料及相同敷料更换方法,观察并比较3组患儿血管内导管相关感染发生率、敷料覆盖处皮肤细菌培养阳性率。结果共纳入296例,7 d、11 d、14 d更换敷料组分别为96例、108例、92例,导管相关血行感染发生率分别为2.5/1000导管日、1.1/1000导管日、0.8/1000导管日;导管病原菌定植发生率分别为1.0%、0.9%、0%;出口部位感染率分别为1.0%、0.9%、1.1%,敷料覆盖处皮肤细菌培养阳性率分别为1.0%、2.8%、2.2%,差异均无统计学意义(P>0.05)。导管相关血行感染及敷料覆盖处皮肤细菌培养以革兰阳性球菌为主,占91.7%(11/12),革兰阴性杆菌占8.3%(1/12),无真菌感染。结论聚氨酯透明敷料在完整且无卷边、渗血、渗液等情况下,早产儿PICC导管置管处敷料14 d内按需更换具备安全性。Objective To study the safety of different peripherally inserted central catheter(PICC)dressing replacement frequencies in preterm infants.Method From June 2017 to February 2020,preterm infants were enrolled in this prospective randomized controlled study.Preterm infants with PICC were randomly assigned into 7 d,11 d and 14 d dressing replacement groups using online randomization software.Polyurethane transparent dressing and the same dressing replacement method were used in all three groups.The incidences of catheter-related bloodstream infection(CRBSI)and positive skin bacterial culture at dressing site were compared among the three groups.Result A total of 296 cases were enrolled,including 96 cases in the 7 d group,108 cases in the 11 d group and 92 cases in the 14 d group.The incidences of CRBSI in three groups were 2.5/1000 catheter day in 7 d group,1.1/1000 catheter day in 11 d group and 0.8/1000 catheter day in 14 d group.The incidences of catheter pathogen colonization were 1.0%in 7 d group,0.9%in 11 d group and 0%in 14 d group.The positive rates of skin bacterial culture at dressing site were 1.0%in 7 d group,2.8%in 11d group and 2.2%in 14 d group.The incidences of PICC exit site infection in three groups were 1.0%in 7 d group,0.9%in 11d group and 1.1%in 14 d group and no significant differences existed among the groups(P>0.05).Gram-positive cocci were the main bacteria[91.7%(11/12)]of CRBSI and skin bacterial culture at dressing site and gram negative bacilli accounted for 8.3%(1/12).No fungal infection were found.Conclusion It is safe to replace the PICC dressing in premature infants as needed within 14 days if the dressing is intact without curling,bleeding and exudation.

关 键 词：导管插入术 中心静脉 婴儿 早产 敷料 血管内导管相关感染 

分 类 号：R473.72[医药卫生—护理学]