中心静脉导管相关性血流感染的危险因素分析  

Analysis of risk factors of central venous catheter-related bloodstream infection

作　　者：唐春艳 罗丹 陈倩 李威 TANG Chunyan;LUO Dan;CHEN Qian;LI Wei(Department of Intensive Care,The People's Hospital of Jianyang City,Jianyang 641400,Sichuan Province,China)

机构地区：[1]简阳市人民医院重症医学科,四川简阳641400

出　　处：《医学新知》2024年第4期417-423,共7页New Medicine

基　　金：四川省医学科研课题计划(S20037)。

摘　　要：目的探究中心静脉导管相关性血流感染(catheter-related bloodstream infection,CRBSI)的危险因素。方法回顾性分析2019年2月至2023年2月于简阳市人民医院行中心静脉置管患者的临床资料,依据患者是否发生CRBSI分为CRBSI组与非CRBSI组。比较两组患者基线资料,采用多因素Logistic回归分析明确接受中心静脉置管患者发生CRBSI的危险因素。采用受试者工作特征(ROC)曲线构建预测模型。结果共纳入304例患者,其中CRBSI组47例(15.46%)、非CRBSI组257例(84.54%)。CRBSI组年龄、BMI、APACHEⅡ评分显著高于非CRBSI组,置管时间显著长于非CRBSI组,合并糖尿病、置管地点为ICU、置管部位为颈内静脉或股静脉的占比显著高于非CRBSI组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,高龄[OR=3.067,95%CI(1.238,7.598)]、高BMI[OR=1.894,95%CI(1.215,2.952)]、合并糖尿病[OR=1.609,95%CI(1.129,2.293)]、高APACHEⅡ评分[OR=2.287,95%CI(1.174,4.455)]、置管地点为ICU[OR=4.106,95%CI(1.600,10.537)]、置管部位为颈内静脉或股静脉[OR=3.416,95%CI(1.583,7.371)]、置管时间长[OR=1.416,95%CI(1.019,1.968)]为中心静脉置管患者发生CRBSI的危险因素。ROC分析证实,年龄、BMI、APACHEⅡ评分、置管时间及多因素Logistic回归模型等均能用于中心静脉置管患者发生CRBSI的预测,且多因素Logistic回归模型可获得更高的曲线下面积[AUC=0.981,95%CI(0.967,0.996)]及敏感度(0.957)、特异度(0.961)。结论中心静脉置管患者CRBSI的发生受到年龄、BMI、APACHEⅡ评分、置管地点、置管部位、置管时间等因素的影响,临床应综合考虑上述因素,及时采取针对应的干预措施,尽早预防。Objective To explore the risk factors for the development of central venous catheter-related bloodstream infections(CRBSI).Methods The clinical data of patients undergoing central venous catheterization in The People’s Hospital of Jianyang City from February 2019 to February 2023 were retrospective and analyzed,and they were divided into CRBSI group and non-CRBSI group.Basic data of the two groups were compared.The risk factors for CRBSI were determined by multivariate Logistic regression analysis.A predictive model for CRBSI patient was construsted through receiver operating characteristic curves(ROC).Results A total of 304 patients were included,including 47(15.46%)in the CRBSI group and 257(84.54%)in the non-CRBSI group.The age,BMI,and APACHEⅡscore in the CRBSI group were significantly higher than the non-CRBSI group,and the catheterization time was significantly longer than the non-CRBSI group.The proportion of diabetes mellitus,ICU site,internal jugular vein or femoral vein were significantly higher than that in the non-CRBSI group,and the differences were statistically significant(P<0.05).Multifactor Logistic analysis indicated that older age[OR=3.067,95%CI(1.238,7.598)],high BMI[OR=1.894,95%CI(1.215,2.952)],coexistence of diabetes[OR=1.609,95%CI(1.129,2.293)],high APACHE II score[OR=2.287,95%CI(1.174,4.455)],catheterization location in the ICU[OR=4.106,95%CI(1.600,10.537)],catheterization site being the internal jugular or femoral vein[OR=3.416,95%CI(1.583,7.371)],and prolonged catheterization duration[OR=1.416,95%CI(1.019,1.968)]were risk factors for CRBSI in patients.According to ROC analysis,age,BMI,APACHEⅡscore,catheterization time and multivariate Logistic regression model were all used for the prediction of CRBSI in patients with central venous catheterization,and the multivariate Logistic regression model can obtain higher area under the curve[AUC=0.981,95%CI(0.967,0.996)],sensitivity(0.957)and specificity(0.961).Conclusion The occurrence of CRBSI in patients with central venous catheters is i

关 键 词：中心静脉置管 导管相关性血流感染 危险因素 受试者工作特征曲线 

分 类 号：R472[医药卫生—护理学]