ICU疑似导管相关血流感染拔管后立即重新穿刺中心静脉导管继发CRBSI风险的回顾性分析  

Retrospective Analysis of the Risk of Secondary CRBSI Caused by Central Venous Catheter Re-puncture Immediately After Extubation in ICU with Suspected Catheter-Related Bloodstream Infection

作　　者：王磊[1] 周亚梅[2] 阿米娜·艾买提 高景宏 马晓荣 蔺国争 范超林 钟一岳 WANG Lei;ZHOU Yamei;Amina AIMAITI;GAO Jinghong;MA Xiaorong;LIN Guozheng;FAN Chaolin;ZHONG Yiyue(Department of Emergency Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Xinjiang Production and Construction Corps 13th Division Red Star Hospital,Hami 832099,China;Hami Vocational and Technical College,Hami 839001,China;Hami Central Hospital,Hami 839099,China;Affiliated Hospital of Guangdong Medical University,Guangzhou 510180,China)

机构地区：[1]郑州大学第一附属医院急诊医学部,河南郑州450052 [2]新疆生产建设兵团第十三师红星医院,新疆哈密832099 [3]哈密职业技术学院,新疆哈密839001 [4]哈密市中心医院,新疆哈密839099 [5]广东医科大学附属医院,广东广州510180

出　　处：《河南医学研究》2023年第19期3487-3495,共9页Henan Medical Research

摘　　要：目的评估重症医学科(ICU)患者发生疑似导管相关血流感染(CRBSI)时立即重新穿刺中心静脉导管(CVC)发生继发CRBSI的风险。方法回顾性分析2009年1月至2018年12月疑似CRBSI的病例,数据变量来源纸质病历、电子病历和检验报告数据库,患者出现疑似CRBSI拔除CVC后对比分析立即重新穿刺和未立即重新穿刺的相关因素,评估继发CRBSI的风险。结果847例疑似CRBSI患者中,立即重新穿刺的患者病情更危重。在控制基线队列中差异有统计学意义的变量后,多因素Cox比例风险模型显示,疑似CRBSI患者拔除CVC后立即重新穿刺显著增加继发CRBSI的风险(HR=6.316,95%CI 4.244~9.400,P<0.001),而发热(>38.3℃)(HR=1.666,95%CI 1.184~2.344,P=0.003)和平均动脉压降低(<70 mmHg)(HR=1.513,95%CI 1.045~2.191,P=0.028)是发生CRBSI的独立危险因素,在联合使用抗生素(>2种)的患者中发生CRBSI的风险更低(HR=0.570,95%CI 0.376~0.864,P=0.008)。结论ICU疑似CRBSI而未诊断为CRBSI的患者中,立即重新穿刺CVC增加继发CRBSI的风险,并且不能降低这些患者的30 d死亡风险。临床需加强对疑似CRBSI患者的关注,为降低立即重新穿刺CVC继发CRBS风险进行早期干预。Objective To evaluate the risk of secondary CRBSI in intensive care unit(ICU)patients with suspected catheter-associated bloodstream infection(CRBSI)caused by immediate re-puncture of central venous catheter(CVC).Methods From January 2009 to December 2018,suspected cases of CRBSI were analyzed retrospectively.Data variables were derived from paper cases,electronic medical records and laboratory report databases.Factors related to immediate re-puncture and non-immediate re-puncture after CVC extraction were compared in patients with suspected CRBSI,and the risk of secondary CRBSI was assessed.Results Among the 847 patients suspected of CRBSI,the patients with immediate re-puncture were more critical.After controlling for variables that were statistically different in the baseline cohort,the multivariate Cox proportional hazard model showed that re-puncture immediately after CVC removal in patients with suspected CRBSI significantly increased the risk of secondary CRBSI(HR=6.316,95%CI 4.244-9.400,P<0.001).Fever(>38.3℃)(HR=1.666,95%CI 1.184-2.344,P=0.003)and decreased mean arterial pressure(<70 mmHg)(HR=1.513,95%CI 1.045-2.191,P=0.028)were independent risk factors for CRBSI.The risk of CRBSI was lower in patients receiving combined antibiotics(>2)(HR=0.570,95%CI 0.376-0.864,P=0.008).Conclusion In ICU patients suspected of CRBSI but not diagnosed with CRBSI,immediate re-puncture of CVC increases the risk of secondary CRBSI and does not reduce the 30-day risk of death in these patients.Clinical attention should be paid to suspected CRBSI patients,and early intervention should be carried out to reduce the risk of secondary CRBSI increased by immediate re-puncture of CVC.

关 键 词：重症医学科 中心静脉导管 导管相关血流感染 继发感染 死亡风险 

分 类 号：R472[医药卫生—护理学]